APC Integrity Program.
The client.
A four-hospital health system in the southeast.
The business issue.
This health system undertook an APC Integrity Program to develop a sustainable infrastructure
(including the integration of new roles and responsibilities, revised processes,
tools, education, reporting and metrics) for accurate and effective management of
the outpatient/APC revenue stream.
The solution.
Professionals from The Claro Group worked with the client to perform an APC Integrity
assessment of the organization's core revenue cycle processes and infrastructure
for charge capture, coding, and billing of outpatient/APC services. The assessment
revealed significant opportunities for revenue and process improvement, and it led
to the implementation of a revised APC infrastructure.
The project included implementation of comprehensive APC reporting software to assist
in identifying issues and monitoring progress.
The project team then worked with the company to implement the APC Integrity Program
over an eight-week period including:
- Developing an operations framework for the newly defined roles and responsibilities.
- Training client personnel in their new roles and responsibilities.
- Providing fact-based issue identification, resolution, and monitoring utilizing
APC reporting software.
- Developing a core team responsible for implementing sustainable solutions to systemic
issues. The core team included key members of ancillary departments, HIM, Central
Business Office and Chargemaster.
- Establishing extensive reporting to measure and sustain results.
The results.
This approach enabled the health system to generate additional annual revenue of
more than $1.5M.
In addition, it created sustainable solutions to systemic issues. These include
targeted coding and clinical training, improvements to system interfaces, Chargemaster
corrections and implementation of improved medical necessity and denial review processes.
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