Challenge
A national acute-care health system with net patient revenue of $9.4 billion was concerned about low recoveries even with a transfer DRG vendor in place. The transfer DRG rule had resulted in a $69 million per year reimbursement decrease, and they knew their recoveries were well short of the 10%–15% industry average.
Solution
The health system engaged PCS, whose analysis identified 2,094 claims that were missed in previous vendor reviews. Within 30 days of utilizing PCS Transfer DRG, the system was able to identify and rebill accounts to recover cash prior to the system’s fiscal year-end.
PCS Transfer DRG has helped the health system achieve continuous improvements by streamlining processes for greater efficiencies and providing enhanced Centers for Medicare and Medicaid Services (CMS) interface capabilities, enhanced reporting and improved benchmarking capabilities with trending insights.
Results
A four-year look-back identified and recovered $6.6 million in lost revenue with an annual recurring revenue recovery of $3.3 million. As a result of the initial findings behind the primary vendor, PCS was awarded the position of primary and sole reviewer for this client.
Financial
More than
$6.5M
revenue recovered from four-year look-back
Operational
More than
$3.3M
revenue recovered annually
