What is spot check? A no cost, no risk study of potential missed revenue opportunities How does it work? E-CS requests a procedures productivity report (commonly created) from the HIM department and E-CS provides to the hospital exactly how to populate the spread sheet How much time does the hospital staff have to expend to do this? About two hours including transmission of the report and a select number of medical records to validate the findings How do we, E-CS, do this? It’s all performed remotely, perhaps a couple of 15-20 minute telephone interviews. The report and records review is all electronic generally via VPN. After we apply software, we go beyond that and review records for suspected opportunities by a 20-year experienced professional. We ask for volumes of particular procedures to extrapolate the findings to generate potential revenue, assuming most errors are made consistently on the particular procedure. As a C-Suite Executive I get mailings and e-mails weekly on Revenue Cycling, how is E-CS different? We are not financial report/software driven. We get into the documentation of records to identify what coding has been missed sometimes $000’s of dollars that are likely to have been erroneously or omitted in the coding process. E-CS has actually subcontracted for Revenue Cycle companies in the past. What do we get as a result of this spot check study? The hospital receives a written report of findings that illustrate where the opportunities can be found and the dollar value. What happens next? The hospital leadership decides if they want to become a client and there are two options; E-CS does the recoding and billing for the previous one or two years, commonly two years. OR the hospital can do the recoding and billing and we supervise. (Generally clients have us do the work because the hospital staff already has its hands full with current work). Who gets paid, what and how? The payors make all payments directly to the hospital, (not E-CS), between 15-30 days of submittal. The hospital pays E-CS 33%, (30% to RWHC members) of the collected dollars within 15 days of the hospital’s receipt of payment. A record of all transactions, findings are kept on a Google Spreadsheet so everyone knows exactly what is going on, payments, etc. Are we then dependent on E-CS? E-CS educates the hospital staff on what we are doing so upstream they have the knowledge to continue proper coding and billing. E-CS DOES NOT participate in revenue capture going forward. If E-CS finds six figure revenue back billing, the six figures belongs to the hospital prospectively. We are not a threat to current staff; we are an asset and educators. How successful has this been? E-CS boasts 100% revenue capture findings of all who become clients. The greatest success story to-date is finding more than $1,000,000 in one CAH.
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