The University of Iowa Health Care has recovered more than $20 million in hospital payments from insurers by employing its own software and a new approach to revenue management.
Beginning last November, UI Health Care adopted an integrated structure for revenue management that encompassed the entire enterprise. The effort allowed closer collaboration and a more seamless flow among finance specialists in the UI Roy J. and Lucille A. Carver College of Medicine, UI Physicians and UI Hospitals and Clinics.
As a result, UI Health Care officials say they were able to recover payments they would otherwise not have received.
"I would say that 98 to 99 percent of the time our payers do a great job of providing us correct and accurate payments," said Tom Mentz, director of revenue integrity for UI Health Care. "Our integrated structure, sophisticated tools and dedicated team allow us to find those few needles in the haystack and to recover all the payments we are entitled to receive."
"Our new unified financial structure gives us more confidence that both we as a healthcare provider and our third-party insurers are complying with those contracts," said Ken Fisher, associate vice president of finance for UI Health Care. "The basic principle of the whole dynamic is 'Trust, yet verify.'"
Revenue integrity staff designed and developed their own software toolset to help monitor hospital payments, a key element in the office's success, said Fisher.
Mentz said another critical success factor is the team's identification and recovery of more than $1 million in physician payments. The team used technology developed by Austin, Texas-based Medical Present Value to audit physician reimbursement.
"It is very impressive to see these high-functioning teams in action," Mentz said. "Their successes are making important contributions to the overall success of the entire enterprise, especially in this very challenging economy."
Another important component in the integrated structure is assigning the correct codes to patient care activities. Ingenix, a national health information technology consulting service and coding reference publisher, recently named UI Hospitals and Clinics one of the "Top 200 Coding Hospitals" in the United States. Of 4,607 hospitals analyzed by Ingenix, UI Hospitals and Clinics placed eighth out of 233 major teaching hospitals.
"When the process begins correctly with proper documentation and accurate assignment of the patient care codes, there are fewer problems down the line, which makes the whole process flow much more smoothly," said Tammi Craft, director of health information management.