Strong revenue cycle performance is essential to maintaining hospital margins and delivering high-quality care. After successfully implementing its EHR billing system, Children's Hospital Colorado recognized there were still additional opportunities not being detected. By deploying VitalIntegrity charge capture analytics to conduct comprehensive daily reviews, the organization identified additional improvement opportunities, enhanced charge capture accuracy, and increased revenue.
Revenue cycle performance directly impacts healthcare organizations’ bottom line and the ability to continue providing high-quality patient care. Poor mid-revenue cycle performance can substantially reduce hospital margins. Recognizing these risks, Children’s Hospital Colorado focused on strengthening its revenue cycle performance to improve margins and sustain high-quality care.
Children’s Hospital Colorado implemented its EHR billing system, identifying and closing charge capture loopholes. Over time, the EHR identified fewer opportunities for improvement. Leadership recognized that additional opportunities were likely still present but not being detected, especially in complex pharmacy and department charges, which traditional systems and audits were likely missing.
The organization needed a system that could create a broader net and identify gaps that the existing audits and rules were missing.
Children’s Hospital Colorado implemented the VitalIntegrity application to enhance charge-capture processes and minimize revenue leakage from under- (and over-) charging, late or missing codes, and mismatched charges and supplies.
The organization uses VitalIntegrity’s charge capture analytics to perform daily reviews of 100 percent of its outpatient itemized charges, enabling a full review of soft-coded, hard-coded, diagnosis, and root cause information.
Using charge capture analytics, Children’s Hospital Colorado identified new improvement opportunities, including discrepancies and overlooked charges for high-cost specialty medications. It also expanded visibility into the emergency department, where missing ancillary, radiology, and supply charges had gone undetected. These insights revealed that there was still considerable opportunity, even after a comprehensive internal review and EHR implementation.
Charge capture auditors use a daily analytics report to review flagged accounts, working from a simple-to-navigate queue, improving charge capture accuracy. The organization customizes and refines rules to identify gaps and root causes, implementing changes to prevent the recurrence of issues.
Children’s Hospital Colorado’s charge capture analytics are improving charge capture accuracy and payment for the services provided. In just one year, the organization achieved a:
“VitalIntegrity gave us visibility into missed revenue, which is invaluable. It uncovers high-value opportunities while minimizing additional workload for our charge capture auditors. It’s a financial and operational win.”
- Andrew Wade, MBA, CHFP, Revenue Integrity Director, Children’s Hospital Colorado
Children’s Hospital Colorado plans to refine and expand its active edits, building sustainable, scalable momentum to further improve revenue cycle performance.
