Kaleida Health

Kaleida Health is the largest healthcare provider in Western New York, serving its community with state-of-the-art technology and comprehensive healthcare services.

• Identifying coding and regulatory compliance risks
• Ensuring charging accuracy
• Optimizing reimbursement
• Ongoing maintenance.

Findings:

    System Connectivity - Leadership understood that due to multiple system interfaces and the complexity of data, a complete 
            review of charge capture was necessary to ensure complete and accurate billing for all services performed.

    Surgical Charge Structure - Despite a significant range of services performed in the OR, 99% of cases were assigned a Level
           2, meaning that intense services were undercharged, and more simplistic procedures were overpriced.

    Strategic Pricing - Chargemaster prices were out of line with market and reimbursement rates, putting KH at risk for public
           scrutiny and reduced reimbursement.

    Pharmacy - Revenue leakage was discovered in the Pharmacy due to missing charges and coding inaccuracies

    Supplies - Volume analysis revealed charge capture improvement opportunities and missing and inaccurate implant codes

Outcomes and Improvements:

    Surgical Charge Structure - Defensible pricing structure – align price to the acuity of procedure within ORs and ASCs.

    Strategic Pricing - Price transparency and market appeal – increase market position and appeal of prices which reduces the
           risk of negative response to pricing viewed by customers. Charges that align with reimbursement rates – "right-sizing"
           pricing to reflect acuity and reimbursement better.

     Supplies - Charging accuracy: coding and pricing for supplies to accurately reflect the type and cost utilized during a case.

    Pharmacy - Implementation of an accurate charge capture process, data system optimization to reduce manual intervention,
           applying consistent charging guidelines for Pharmacy, resulting in increased reimbursement.

    System Connectivity - Order Entry System to CDM data analysis, mapping, and charge capture improvement.

Sustaining Improvements

MedCom acknowledges that a successful program must be monitored and cultivated to thrive. Our organization provides ongoing support that extends past the conclusion of any engagement to ensure an effective program and exponential growth in the years that follow.

MedCom manages ongoing improvement through a trio of revenue cycle solutions, which includes MedCom's proprietary SaaS solutions and team involvement:

• Identifying coding and regulatory compliance risks
• Ensuring charging accuracy
• Optimizing reimbursement
• Ongoing maintenance.