Abstract
Background: In 2018, our respiratory department noted large losses of revenue due to incorrect staff documentation. A continuous improvement project was completed in December 2018 in order to streamline documentation in an effort to increase revenue generation. While charge errors were reduced after documentation changes numerous opportunities were still missed that decreased gross revenue. We aimed to evaluate the impact of an auditor on gross billed charges within our department.
Methods: A trial position was created, where an internal RT candidate (fully oriented and experienced staff RT) transitioned into a full time RT auditor role (11/1/2020–1/31/2021). Minimal one-on-one training was completed with the clinical instructors of the respiratory department. The auditor worked 3pm–11pm, Monday- Friday, to capture both dayshift and nightshift documentation in real time. IRB approved retrospective financial analysis was completed to assess the financial impact of the RT auditor. Errors were categorized by total errors (TE) and not-billed errors (NB). TE included any charge related discrepancies (eg, no order, not documented, documentation frequency) and NB-included errors where only the charge was missing from documentation.
Results: In comparison to the same months in 2019, the hospital claims audit team found 43% less TE and 53% less NB in the 2020 trial months. January 2021 had 53% fewer TE with 79% fewer NB than January 2020 (Figure 1). Of note, the workload units were 8% less in Nov–Dec 2020 versus 2019 and 20% less in January 2021 versus 2020. After trial completion, we analyzed documentation errors and revenue generation for the following month. In the month following the trial (no RT auditor), there was a 48% increase in NB. The real time RT auditor was able to produce an increased gross billed revenue from chart auditing by $341,000 in 3 months.
Conclusions: The real time RT auditor was able to produce increased gross billed revenue from chart auditing. The position required minimal training, and revenue gains well outpaced expected clinical productivity of the RT auditor. Aside from increased revenue, there was a decrease in documentation errors, increased quality of RT documentation and recognition of improvement by our hospital’s claim auditor manager. The utility of this position and high benefit of a fully trained RT auditor, raises a potential new career opportunity for respiratory therapists.
Figure 1 shows the number of audit findings by the claim anaysts (reviewed after patient discharge and prior to insurance billing) during the real-time RT auditor trial period.
Footnotes
Commercial Relationships: Katlyn Burr, HillRom, Patient Trainer
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