Simple changes to improve emergency department revenue

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Revenue Cycle / Supply Chain

Todd Schneider
Improvement Advisor and Management Engineer
Tallahassee Memorial HealthCare

This presentation follows the journey one organization took to simplify their charging process while simultaneously increasing reimbursements by $200,000 per month. Updating the charge description master, increasing the percentage of reimbursable items, and creating an online process to capture charges were important factors to this improvement. We will discuss the importance of charge description master maintenance, insuring that all reimbursable codes are in the charge master and that the charge levels are appropriate.

The biggest update was related to the addition of procedure charges. Charge amounts for medication administration were increased based on a comparison of other organizations. We will also discuss the impact of reducing items on the charge sheet. In order to have room for the additional charges, the charge sheet was modified and many items were removed. The items removed were either non-reimbursable or of low cost. These changes were implemented in May 2005 increased reimbursements by $200,000 per month (for patients discharged from the EC).

Finally, we will discuss how utilizing an online charge form can decrease the time it takes for staff time to enter charges, decrease failed bills, and increase charge capture. The charge form was placed online with an emphasis on procedures, injections, vaccination administrations, and high cost supplies. Most other items were removed from the charge form or grouped into other charges. Each item removed was built into an existing charge, so the changes were charge-neutral. The online form also included some required fields so that every patient was required to have a facility charge prior to discharge and the nurse was required to review the other charge forms. The online charge form also allowed for the charges to automatically pass to the financial system, eliminating the need for a tech to work overtime to enter the charges. As a result, the fewer late charges were entered.

This new online form was implemented in May 2006. We have also seen an increase in the average EC charges per patient by about $40, and the EC sees approximately 200 patients per day. Although it is too soon to see the impact on revenue, the numbers of procedure charges entered have tripled and entries of other high charge items have also increased. We expect that these increases will also correlate to increased revenue for discharged EC patients.