Results: Less Effort. Greater Impact.
With just a few clicks, the hospital IT staff and contract monitoring employees were able to bring in fresh data each week or month and browse the database of exported files. They now had a self-service process to search for overpayments, underpayments, timely payments, denied claims, and other discrepancies that required further research.
The team went from a manual process of reviewing only a sample of claims paid each week to review 100% of the claims to ensure that reimbursement amounts were in accordance with provisions in the contracts. Hospital staff immediately found discrepancies that required further attention, some of which totaled thousands of dollars.
During the development of the IDEAScript, Peters identified a provision in the contracts that impacted the reimbursement rate on inpatient procedures. The provision enabled the insurance company to pay the hospital’s chargemaster rate if it was lower than the insurance company’s contracted case management rate. Peters identified several inpatient procedures that needed to be updated on the hospital’s chargemaster to avoid missing out on thousands of dollars per claim for those procedures. The hospital adjusted contractual differences between its prices and contracted payer amounts. They were also able to check for updates on set payment amounts to ensure the insurance companies were not defaulting to the lower chargemaster rates.
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