Streamlined ICD-10 Coding and Charge Entry Procedures for a Regional Multi-Specialty Hospital and Group Practice

Enhanced Revenue Solutions (ERS) by Infinx partnered with one of the Midwest’s largest multi-specialty hospitals, and group practices (the Practice) that was experiencing significant revenue shortfalls brought about by unforeseen staffing challenges and a significant backlog in charge capture procedures. With a team of over 70 board-certified physicians and Advanced Practice Providers (APP) staffing 12 regional locations, then Practice found itself with a massive inventory of claims that needed to be coded, entered, and submitted for reimbursement. With timely filing concerns of paramount importance, the Practice enlisted ERS to implement a recovery plan.

Coding Solution

ERS deployed three highly experienced Cardiology coding specialists to assist the Practice in executing all necessary coding procedures and provided round the clock support to clear the entire inventory of unprocessed claims. With an ERS Client Service Manager heading up the team, codes were assigned, and documentation verified, leading to a 99% acceptance rate by the Practice’s insurance payers and reducing claim denials substantially.

Charge Capture Solution

With skilled ERS EPIC-trained specialists, the entire inventory of backlog of over 500 claims was readied and submitted within 12 hours. Once systematized and distributed, ERS was able to maintain the workflow and continued to see improvement in charge capture and submission rate.

The Practice met and exceeded their desired productivity rate and the entire inventory of uncoded and unprocessed claims was expedited and electronically submitted to their respective third-party insurance payers for reimbursement. This seamless and organized workflow lessened the chance of rejection or denial for timely filing or missing information while maintaining quality and adding directly to the Practice’s bottom-line.

Working with ERS, the Practice was able to:

• Increase claims submission by 20% in the first two weeks with continued increases going forward to present.
• With ERS as an ongoing RCM partner, the Practice saved time and resources on hiring and training qualified coders with ready knowledge and experience on the EPIC system.

1. Coding expertise with over 98%+ accuracy rate
2. Quantifiable productivity benchmarks
3. Internal audit and quality control
4. Robust reporting methodology and technology enablement
5. Benchmark cost efficiency