This brings me to Christus Health in Irving, TX one of the largest Catholic Health Systems, which decided to prioritize consistency in the charge capture of its emergency department levels and injections/infusions and wound up recovering a whopping $29 million in net revenue.
The ability correctly and consistently do charge capture for the ED and with injections and infusions confounds everyone from physicians and nurses to billing staff at many hospitals, and Reggie Allen, MBA, RN, system director of quality and clinical operations at CHRISTUS, knew that was the case at his facility.
“We noticed we were inconsistent in our charges across the emergency department and when we looked the situation, we realized that all of our facilities were all using different paper based tools to do their EM coding and charging. When we plotted this out, we found that not only were many of them not charging for things they could, but they were selecting a lower level code to charge the patient,” Allen explains.
With more than $4.1 billion in assets—$3.1 billion in net revenue—and over 40 hospitals and other healthcare facilities in six U.S. states and Mexico, all those missed charges were adding up. This was also a compliance issue, Allen says, they needed to improve their documentation and consistently charge what was appropriate for the patients’ care or risk government and payer scrutiny.
“We thought we were possibly losing around $10 million,” Allen says, and that was only for the emergency department level charges—accounting for more than 577,550 visits a year. With 21 ED and outpatient clinic sites to track they knew these areas could offer them a swift return on investment, but would also be a good testing ground for whatever solution they selected. Now they just needed to figure out how to correct the problem. Allen began searching for a program that could help his staff consistently bill for infusions and injections.