Are your coding audits revealing missed procedures? Do you have a Charge Capture reconciliation process in place? Are your key areas reconciling charges? Have you automated the Charge Capture process where Possible?
How many of your denials are going unresolved or unappealed? Over 60% of denials go unworked. How many of your appeals are you winning? How is your denial team structured? Do you have clinical team members working the higher-complexity, clinical denials?
Missed ICD1O Codes:
Are you capturing all of the diagnosis codes you need to be? Are they prioritized correctly? For inpatients in particular, what does your severity classification and MCC/CC capture rate look like?
Are you collecting at least 25% of all patient balances due at the time of service? On the back-end, are you collecting at least 50% of all Balance After Insurance (BAI) due? Do you have an Early Out vendor to call on patients prior to sending them to Bad Debt? What is their collection rate?
How many of your insurances pay you 1OO% of the contracted amounts (probably not many)? What is your average reimbursement compared to the expected amount? Do you track this by payer? Do you have a team to follow up on underpayments and what is their recovery rate?