Case Studies

An emergency department in the Southeast US with more than 40,000 patient visits used the hospital’s multi-specialty coding team, but was experiencing below average patient charges and collections.

Challenges

A lack of documentation education and feedback resulted in poor documentation quality, negatively impacting the overall revenue of the emergency department.  Additionally, concerns about downcoding were confirmed when Marina audited a sample of the emergency department’s charts.

Further evaluation of the department’s receivables showed below average reimbursement from Medicare, Medicaid, and other prominent insurance payors.

The Marina Solution

Marina’s comprehensive services include customized documentation education and regular feedback to help physicians accurately document the medical decision making process that occurs with their patients.  Our thorough and meticulous billing protocols ensure payments received match contracted reimbursement rates.

Results

Collections for this emergency department have increased more than 41%, and Marina is exceeding original projections by 19%.  A customized documentation program including monthly feedback has improved the overall quality of documentation significantly.  Deficiencies have declined by 85%, resulting in an additional $275k in revenue annually.

Furthermore, Marina’s appropriate and accurate CPT coding improved the acuity profile to properly reflect the acuity of the patients treated in the emergency room.

Marina also improved the Managed Care reimbursement terms for two of the group’s largest PPO payors.  Each payment received from these payors, as well as Medicare, Medicaid, and other contracts are matched to the payors’ contracted rates, ensuring proper payment and maximized collections.

A large emergency physician group in the Pacific Northwest experienced significant chart flow problems, drastically impacting their overall collections.

Challenges

The billing protocols of the previous coding and billing company did not include a chart reconciliation process, and missing charts and chart components were not captured, resulting in lost revenue.

Poor documentation and coding accuracy led to further losses in revenue.

The Marina Solution

Marina’s full service coding, billing, and revenue cycle management services include a comprehensive review of the group’s chart flow process, chart reconciliation to the ED log, customized documentation education and feedback, as well as quality coding and billing practices.

Results

The group’s revenue has increased 32%, generating more than $12M in additional cash collections annually.

Marina instituted an efficient and paperless chart flow process which includes daily reconciliation to the ED log to accurately reflect patients left without being seen, as well as capture all missing and incomplete charts.  All missing and incomplete charts are researched prior to coding.

Overall documentation has improved due to customized documentation education, further increasing the group’s annual collections.  Marina’s tailored program includes regular feedback showing areas for improvement and a series of onsite training sessions customized according to the specific documentation trends of the group’s physicians.

The ED group of a prominent hospital in the Pacific Northwest was concerned about coding accuracy when a physician’s referral brought them to Marina.

Challenges

The group’s coding and billing was managed by a third-party, collecting a modest $96 per patient.  Along with low accuracy, insufficient reporting and documentation feedback were factors in the group’s low collections.

The Marina Solution

The group partnered with Marina for coding and billing services, and receives practice management assistance for fee schedule analysis, customized reporting, and documentation education.

Results

By improving documentation, coding accuracy and data driven reporting, overall collections increased by $2.1 million annually.

A tailored documentation education program was designed to provide feedback based on actual coding results.  Feedback is provided by group and individual physician, showing areas for improvement based on each physician’s respective charts.

Customized reports were also developed to further analyze receivables, as well as manage charity programs.

Today, the group has a paperless chart flow process utilizing Marina’s proprietary mPower system.  Expeditious chart transfer, reconciliation, and physician communications contribute to an accelerated billing process.

A Northeastern emergency department with more than 25,000 annual patient visits was beset with enrollment and contracting issues and outstanding accounts receivable.

Challenges

Many of the group’s providers were not properly credentialed and enrolled with their various payors leading to unpaid claims and excessive days in AR.

A lack of proper chart flow procedures allowed approximately 5% of all billable charts to go unbilled, and therefore uncollected.

The group received little documentation education and feedback, which resulted in insufficient documentation and subsequently lower collections.  The group also lacked adequate and proactive information from their billing company to manage the financials of their department.

The Marina Solution

The physician group chose Marina to provide professional fee coding, billing, and comprehensive practice management services.

Results

A combination of Marina’s standard quality assurance processes for chart capture, proper credentialing enrollment with payors, and a customized program of documentation education and feedback resulted in a $30 increase to the group’s average patient payment (APP).  Overall collections increased 25%, or more than $1M annually.

Marina properly credentialed and enrolled each physician with the group’s contracted payors to ensure timely and proper reimbursement.  Monthly billable charts increased approximately 5% after implementing an efficient chart flow process to capture missing and incomplete charts.  Marina further implemented paperless chart capture, as well as electronic claim submission with each payor.  The group’s days in AR decreased by 36% due to these process changes.

Two emergency departments for a prominent West Coast university hospital system see more than 60,000 patient visits annually.  They sought proposals for their emergency department coding and billing along with Toxicology and Hyperbaric units.

Challenges

These two emergency departments experienced below average collections.  Further investigation showed these emergency departments, as well as the toxicology and hyperbaric units, lacked thorough follow up with government and third-party insurance payors to ensure all payments were received and matched contracted rates.

The Marina Solution

Marina’s comprehensive coding and revenue cycle management services include thorough follow up on all government and third-party insurance payments.  Meticulous verification processes ensure every payment received on a claim matches the emergency department’s unique contract specifications.  A team of billing professionals dedicated to this emergency department follows up with each payor until the balance of the claim is satisfied.

Results

Collections for these two emergency departments have increased more than 83%, totaling approximately $3M in additional revenue annually.