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DCH Regional Medical Center

Tuscaloosa, AL

CLIENT

DCH Regional Medical Center (“DCH”) is a three system hospital group with a total of nearly 900 beds located in Tuscaloosa, Alabama providing a wide range of inpatient and outpatient services. The hospital system handles nearly 100,000 outpatient visits per year and has gross revenues of over $1.5 billion.

PROBLEM

DCH was concerned that all outpatient charges were being captured particularly in the Cardiology and Emergency Room. Due to the high outpatient volume, there was no effective way to look at all claims where there was a concern and DCH needed a solution that not only looked retroactively for potential undercharges, but also would give them an understanding of how to proactively find missing charges going forward.

RESOLUTION

re|solution was engaged in 2006 to look at all outpatient Medicare claims back to October 1, 2004. Every claim was analyzed using proprietary software for potential undercharges. The medical record was reviewed to validate that the charges were missed and for those that an opportunity existed, DCH departmental personnel were notified of the potentially rebilling for their review and approval.

RESULTS

Over $700,000 in additional reimbursement was found for DCH after the medical records review and rebilling effort. In addition to the additional cash a significant error in the charge sheet methodology was found and fixed in the cardiology group resulting in significant increased cash for that group going forward. While the increased cash was a pleasant outcome for the engagement, the training related to charge capture, medical records documentation and other issues that was undertaken after gaining an understanding of the problems was significant to the staff and resulted in much improved results after the engagement ended. DCH is now working with re|solution on a continued Medicare reimbursement review with a particular emphasis on bundling/unbundling issues.