5 Key Sources of Revenue Leakage for Hospitals

Kelley Blair, vice president of professional services at Craneware, identifies five key sources of revenue leakage.

1. Multipliers for drug units. Often the unit used in the pharmacy is not the same as the billing unit. For example, a drug is billed at gradations of 0.5 milligram, so a 50-milligram dose requires a multiplier of 100. Hospitals can lose a lot of money when the multiplier is not checked for accuracy. "A keying error or multiplier error could have a huge impact," Ms. Blair says.

2. Interventional special procedures.
When a mobile team goes around the hospital performing interventional special procedures, such as peripherally inserted central catheter lines, pain management and post insertions, the claim for its services could be attributed to the mobile team itself or to the hospital unit where the procedure takes place. "Someone needs to make a decision on this," Ms. Blair says. If both charge for these costs, it is a compliance issue; if neither charges for them, the hospital does not get paid at all.

3. Chargeable supplies and devices. This category includes pacemakers, an expensive item that should not be overlooked, Ms. Blair says. There is no line item in the charge master to charge for these items, so it has to be entered as "miscellaneous — no coding on charges through clinical system." Because it is entered as miscellaneous, it can’t be tracked for accuracy. Clerks entering the information need to be made aware of this. "If you have a paper system, tracking this charge requires looking through four or five pages of supplies used," she says. Also, perform regular back-end clean-up process to make sure these items were reported.

4. Surgical components in radiology. This involves PICC line insertion in infrequent operations. One example is arthrogram injections when they involve an MRI scan. "Often the MRI gets charged and the rest of the procedure is forgotten," Ms. Blair says. To capture this charge, "someone has to have the knowledge and the awareness that some separately billable event has happened and requires more action," she says. New staff may not realize this, so they will need to be educated.

5. Infusion therapy. Since charges are based on the time it takes for this procedure, "you need someone to track and report the time," Ms. Blair says. Also, the order in which the charges are reported affects the level of the billing. "Be careful how you list these procedures on the bill," she says.

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