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Forrest General Hospital

Hattiesburg, MS

CLIENT

Forrest General Hospital (“FGH”) is a 511 bed level II regional trauma center hospital system. The hospital employs over 3,600 people with 250 physicians on staff. The hospital handles over 50,000 outpatient visits per year and manages a Cancer Center and provides a wealth of other healthcare services for the citizens of Southern Mississippi.

PROBLEM

Like many health care providers, FGH was caught with a significant increase in outpatient visits and an ever-expanding set of coding rules to attain reimbursement. Sheer outpatient visit volume prevented FGH from effectively monitoring all claims to insure that all services were being coded and that all work performed was resulting in correct reimbursement.

RESOLUTION

re|solution was engaged in November 2006. All Medicare outpatient claims for the period from October 2004 through December 2006 were reviewed. Using proprietary software, remote coders, and a proven process, re|solution initiated a review of every claim filed during the period under review.

RESULT

Based on the roadmap created using re|solution’s proprietary software, over 38,000 claims were reviewed, over 10,000 edits were flagged and nearly 800 claims were re-billed. This resulted in over $348,000 in additional reimbursement to FGH. The improved reimbursement was significant, but just as significant was the process improvements and compliance issues that were identified. Using this information, FGH will have these benefits and improved reimbursement continue into the future.

“The results speak for themselves and we were very pleased with the professional staff that re|solution assigned to the engagement. We have uncovered many process improvements that will help us improve our reimbursement going forward.”

Denise Waits – Revenue Cycle Director

Forrest General Hospital