St. Luke’s Uncovers $1.3 Million in Missing Net Revenue Associated with Physician Charge Capture Opportunity

Challenge

Leaders at St. Luke’s University Health Network have a well-performing revenue cycle team but were concerned that they might be leaving money on the table due to professional billing charge capture issues. The nationally recognized nonprofit, which provides services at 15 campuses and more than 300 sites across nearly a dozen counties in Pennsylvania and New Jersey, engaged Guidehouse to perform an assessment and develop solutions for improvement. After a thorough review of key charge capture processes, professional billing for inpatient rounding visits was identified as the area with the largest net revenue opportunity.

This area is particularly challenging for many health systems, not just St. Luke’s. Coding rules for billing professional inpatient rounding charges are complex. Additionally, revenue integrity departments typically prioritize reconciliation of hospital charges over professional charges; however, due to the high volume of professional charges, they can add up and should not be overlooked. Lastly, Epic reporting must be customized and maintained, which can become difficult as the organization changes or grows, especially for reports maintained by individual end-users.

Solution

Guidehouse took a two-prong approach to help St. Luke’s capture the professional billing charge capture opportunity identified and eliminate the pitfalls stemming from coding complexities and missing charges. They updated the logic for their Epic Inpatient Note Reconciliation Report and created an executive-level dashboard with the data in Tableau.

The Tableau dashboard shows how many notes with missing charges are reviewed and reconciled each month. The data is broken down by specialty and provider and shows six months of data, which allow leaders to identify spikes in missing charges by provider and quickly react.

The dashboard helped the team discover a subset of providers whose charges were not triggering due to a physician Epic charging template build that needed updating in collaboration with IT and credentialing.

The dashboard also helps leaders review overall reconciliation efforts. Because it shows how many notes are reviewed each month, a leader would be able to recognize a decrease in the volume of notes reviewed and ask their team about the trend. They may learn that their team has not been able to keep up with the volume of notes to review and need additional resources. The dashboard also shows how many of those validated missing charges are pending review by providers. This level of detail allows leaders to hold all stakeholders accountable for charge capture reconciliation.

Impact

Through the engagement, Guidehouse identified about 20,000 notes containing missing charges — representing $1.3 million in missing net revenue. The charges that were missed were billed retroactively, and providers now have the appropriate charging templates to ensure appropriate billing going forward.

This professional billing charge capture initiative not only benefits the health system, but also offers advantages to individual providers. They gain additional work relative value units (wRVUSs), and potentially additional compensation as missing charges are billed, further enhancing the impact of this initiative.

With their new Tableau dashboard, St. Luke’s leaders can monitor the team’s charge reconciliation efforts, catch spikes in missing charges, and quickly identify and address any new charging issues.