MultiCare Health System (MultiCare) recognized it had an opportunity to improve its charge capture processes and reduce losses. The organization sought a solution that was scalable, reduced errors, and increased profitability. MultiCare leveraged its analytics platform and a charge integrity analytics solution to enhance its ability to efficiently manage its charge capture processes, providing access to timely and actionable insights and enabling efficient root cause resolution.
Charge capture is a critical component of the revenue cycle performance. Inaccurate charge capture jeopardizes revenue and regulatory compliance. Up to one percent of a health system’s net charges, a significant amount of money for any healthcare organization comes from lost charge capture opportunities.1 An efficient strategy for charge integrity is essential for financially healthy organizations.
MultiCare experienced changing payer reimbursement and billing guidelines as well as significant and extensive growth, which resulted in increased compliance issues, denials, adjustments, and frustration among both patients and clinical department leaders. The organization recognized that its people, processes, technologies, and tools had not kept pace with the changing environment, creating gaps between the needs of the organization and the output of its revenue cycle department. MultiCare assessed the alignment of its revenue cycle performance with its organizational strategy and executive expectations. It recognized the need for a solution that would optimize charge integrity analysis by proactively identifying issues and providing root cause resolution that was scalable with growth, promoted reduced error volumes, and improved net revenue.
MultiCare developed a robust charge integrity audit program to improve revenue cycle performance and increase net revenue. It focused its efforts on improving its people capabilities, processes, and technology.
MultiCare leverages the Health Catalyst® Data Operating System (DOS™) platform and a robust suite of analytics applications for its data and analytics. The organization chose to implement VitalIntegrity™, a web-based analytics solution that empowers organizations to efficiently manage hospital charge capture processes by detecting and remedying compliance issues and supports the organization’s overall goal of improving reimbursement and compliance. MultiCare uses the analytics solution as part of its proactive issue identification and resolution process, allowing the organization to recognize inefficiencies and revenue leakage from missed charges, identify compliance issues from overcharging, and facilitate tracking of inaccurate charges down to the root cause. The organization conducts three different types of audits: daily, systematic, and random.
MultiCare accelerates organizational learning by ensuring communication of performance to stakeholders at multiple organizational meetings and routinely publishing its audit findings and reports. The organization creates and distributes an executive scorecard, publishes content to the revenue cycle and CDM website, and uses newsletters to share information with a broad audience.
MultiCare has gained access to timely and actionable insights by leveraging its sophisticated revenue integrity analytics solution, enabling the quick resolution of time-sensitive charging errors that affect optimal reimbursement. The organization’s people, process, and technology changes are delivering the desired results. In just three months, MultiCare has recognized:
The organization also identified $36.6M in additional annualized gross revenue at risk of not obtaining optimal reimbursement or resulting in downstream denials and payer audits. MultiCare can now intervene to retain this revenue.
“MultiCare Health System leveraged Health Catalyst’s DOS platform and VitalIntegrity solution to efficiently identify and resolve charge capture issues, retaining $6.1M in net revenue in just three months, while supporting root cause analyses for ongoing process improvement.”– Nicole Gorder, MBA, Executive Director of Revenue Integrity & CDM,
MultiCare will continue to leverage VitalIntegrity to improve charge capture integrity and further advance revenue cycle performance.