Charge Capture
Credit Balance Management
Strategic Pricing
Underpayment Recovery

ISSUE:
A multi-billion dollar health system was in the midst of standardizing their CDMs and prices for all services enterprise-wide. Although that was proving to be a difficult experience, the bigger challenge was determining how they would be able to maintain appropriate usage of the CDM by 5,000+ clinicians and ensure critical revenue was not lost.

SOLUTION:
After learning that the system's nurse auditors could not effectively or efficiently perform claim audits manually, the health system looked at several third-party charge capture products. After a thorough evaluation of each product, it was determined that the traditional products fell short, offering generic 'rule-based' logic which was unable to automatically detect facility-specific trends, anomalies and nuances.

Determined to find an innovative, data-driven approach, the health system turned to MethodCare to leverage its predictive analytics and intuitive workdrivers. MethodCare's Charge Capture Solution provided the capabilities to identify basic missing charges, but more importantly, the solution automated the detection of each instance where a practitioner simply forgot to enter a charge. The predictive analytic solution processed every claim at the individual account level and flagged any account having missed charges.

RESULTS:
Identified 1% of additional revenue
Detected missed charges with greater than 90% accuracy
Highlighted anomalies in charging practices between facilities
Provided workdrivers to validate flagged claims, eliminating costly manual processes