Challenge
A Southeastern medical center misinterpreted guidelines and underreported charity care for both insured and uninsured patients.
Solution
R1 reviewed the claimed charity and bad debt in preparation for an audit and performed a detailed policy review. R1’s regulatory expertise and proprietary S-10 technology were used to analyze electronic claims data to capture hidden reimbursement and uncover compliance issues.
Results
With R1’s help, the medical center was able to increase the identification of uncompensated care by nearly $4 million, a 53% increase from the general ledger approach previously utilized. Qualified charity care increased by over $2 million, which doubled the medical center’s charity care for both insured and uninsured patients. Total bad debts increased by 27%.
$4M
increase in identified uncompensated care
53%
increase compared to legacy general ledger process
$2M
increase in reported charity care costs
More in Regulatory Compliance, Reimbursement, Worksheet S-10
Healthcare’s $200 Billion Translation Problem
