Task 2 - D190
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School
Western Governors University *
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Course
D190
Subject
Medicine
Date
Jan 9, 2024
Type
Pages
8
Uploaded by MajorGalaxyFrog30
Kaitlyn Walker
Student ID: 011051329
Task 2: Data Analysis in the EHR
Explanation of Trend Related to Department
Accounts that are discharged but not final billed are accounts that have
delinquencies causing them to not be coded or billed. We have pulled such accounts
from the EHR and placed them into a spreadsheet to review the data for any possible
explanations and solutions to shrink the DNFB list.
Per the data compiled from the Records Waiting to be Dropped from the DNFB
spreadsheet, we have discovered a few trends that should be highlighted and brought
to higher management’s attention. The spreadsheet yielded lists of basic patient
demographics such as if they were a readmit, the hospital unit they were assigned to,
their attending physician, and their payor type. After reviewing the data, we discovered
that the highest dollar amount not billed, the most readmitted patients in less than 30
days, and the most number of accounts not billed belonged to cardiology.
Identification of Two Physicians with the Highest Pending Dollar Amount
Along with cardiology having the highest dollar amounts, the two physicians with
the highest pending dollar amounts belong to cardiology as well. Doctors Carpenter and
Abboud have a combined amount that is just over $1.7 million from just two accounts
not billed.
Relationship between Readmits and Diagnosis Codes
During our review of this data, we discovered that there are numerous
cardiology-related ICD-10 codes connected with a readmittance of less than 30 days.
However, the most frequent code that reappeared was I33.9 which is the code for acute,
subacute endocarditis, unspecified, according to AAPC (n.d.). There were 3 accounts
total with this diagnosis code and many others that fell under the cardiology specialty.
Readmits have a relationship with diagnosis codes concerning more severe conditions.
The cardiology specialty has many diagnosis codes and conditions that are flagged as
severe and/or life-threatening, so naturally having a higher readmit rate than other
specialties is expected, as is having a higher dollar amount to be billed for with so many
complex procedures and treatments for cardiology patients.
Analysis of Financial Impact
In general, hospitals adjust expenditures to be a constant proportion of their
revenues. Hospitals can use what is called rolling forecasting, a planning approach that
allows healthcare leaders the flexibility to use hospital data to predict future
performance, according to Strata (n.d.). For example, looking at a previous month or
quarter’s revenue versus expenses for loss or profit and advising factors of future
income/expenses accordingly.
The total dollar amount from the DNFB report list was $6.6 million. The first
solution would be to get as many accounts to final billed status as we could to make up
for the loss of revenue. However, most insurance companies have a 90-day claim
deadline to file claims from the date of service, according to Drella (2023). From the
DNFB report, two accounts are either at or over this deadline mark. This means that
these two accounts, which together total $85,359.68, are a complete loss for the
hospital as will have to be written off. For an adequate discussion, we will use an
example hospital budget of $68.3 million for our hospital. This example budget was
pulled from a county-wide hospital system organization (MCHD,2022). A $68.3 million
budget with a loss of revenue from the DNFB list total dollar amount for all accounts of
$6.6 million, lowers our annual budget to $56.7 million. If we were to use the rolling
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forecasting method, the $6.6 million loss from the previous quarter would be evaluated
and our income/expenses sources would need to be adjusted in order to make a profit
and not have us operating at a loss. With the loss in revenue coming from the non-billed
accounts, we would need to look at other sources to make up that income, or research
different areas to implement expenditure budget cuts. Budget cuts not only have the
possibility to affect wages and/or raises for our employees, but can also directly affect
our patients and our standard of care. This in turn affects our performance quality, which
depending on the federal government reimbursement programs requirements, can
affect our standings and reimbursement rates.
Typically, hospitals have a general fund in place, grown from years of operating
at a profit. This fund can be used as a backup source of income to balance any
expenses over revenue amounts. However, without an increase from a general source
of income, doing so will decrease the budget each year following until a profit is seen.
General sources of revenue for a hospital include patient care services, both inpatient
and outpatient, room and board for admitted patients, X-rays, physical therapy, and
nursing care, according to Centers for Health Affairs (2020). Since these general
sources of revenue are not being fulfilled from the non-billed list, we must look into
nonpatient care services for income. These are things such as parking garages,
cafeterias and gift shops, investments, and grants or donations, according to Centers
for Health Affairs (2020). Increasing our nonpatient care services amounts and seeking
new sources of investments and grants is not a simple process. $6.6 million may not
seem like a lot in terms of our overall budget, but even a fraction of the total budget
becoming a loss can have negative results on our bottom line and our annual budgets
for coming years.
Memo Summarizing Findings
DATE: 12/7/2023
TO: Chief Financial Officer of Felder Hospital
FROM: Kaitlyn Walker HIM Manager
RE: Findings from DNFB Report
Key Messages & Background
Totals from all accounts listed on DNFB report - $6,671,331.72
Specialty with highest dollar amount - Cardiology
Specialty with highest readmits - Cardiology
Specialty with highest count of DNFB accounts - Cardiology
Diagnosis Code with highest count of readmits - I33.9; acute and subacute endocarditis,
unspecified.
Diagnosis Code with highest not-billed amounts - I23.6; thrombosis of atrium, auricular
appendage, and ventricles as current complications following acute myocardial
infarction.
Accounts with 90+ days since discharge - 2; totalling $85,359.68
Summary
The finding from the DNFB report show trends of the cardiology specialty being the unit
that has areas of improvements to be made. Suggested implementing new policies and
procedures to help alievate the higher dollar amounts on the DNFB list, and reverse the
amount of possible revenue loss. Accounts listed on the DNFB report are all missing
physician information on chart that needs to be completed and signed before accounts
can be coded and billed. Policies and procedures of more sanctions for physicians who
do not complete their charting responsibilities before the 90-day discharge mark could
help to lessen the accounts on the DNFB report. If claims are not submitted to
insurance for repayment by their filing deadlines then the patient will need to pay for the
services out of their own pocket, since the insurance company is not covering the
expenses, according to Drella (2023). The odds of the patient paying for the entire bill
out of pocket are not high, as most patients will end up negotiating the final bill to a
reduced cash pay price, or not paying it at all and having it sent to collections. In these
instances, the hospital would have to submit the billed balance as a timely filing
write-off. “A timely filing write-off occurs when a healthcare provider or medical billing
entity decides to write off a patient’s outstanding balance instead of pursuing payment
from the patient” (Drella, 2023). These write-offs have a negative financial impact on
healthcare providers and the hospital as they essentially absorb the cost of the services
that were not properly submitted to insurance.
The amounts totaling for cardiology alone that could be brought to final billed status
would bring in an estimated revenue of $4,289,337.87. This amount is over half the total
for the whole DNFB report, forming an action plan and reviewing it with the cardiology
department should be a high priority for recovering a large sum of lost revenue.
If these accounts are not completed and brought to final-billed status, the hospital is at
risk of losing out on a primary income source.
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The financial impact for our hospital of losing $6.6 million in revenue is a negative chain
reaction in terms of our combined budgets for the year. It could also affect the budgets
in the coming years, especially if these issues are not resolved and the DNFB list
continues to grow for the next quarter.
Sources Cited
AAPC (n.d.).
ICD-10-CM Code for Acute and subacute endocarditis, unspecified I33.9
.
Codify.
https://www.aapc.com/codes/icd-10-codes/I33.9#:~:text=ICD%2D10%20code%2
0I33.,Diseases%20of%20the%20circulatory%20system%20
.
Strata (n.d.).
The Basics of Healthcare Budgeting and Capital Budgeting
. Syntellis.
https://www.syntellis.com/guide-to-healthcare-and-hospital-budgeting#:~:text=Wh
at%20is%20a%20budget%20in,operating%20costs%20and%20capital%20equip
ment
Drella, M. (2023, December 8).
What Medical Practices Need to Know about Timely
Filing
. Outsource Strategies International.
https://www.outsourcestrategies.com/blog/medical-practices-need-timely-filing/#:
~:text=If%20a%20specific%20insurance%20company,from%20the%20date%20
of%20service
.
MCHD (2022).
Montgomery County Hospital District Annual Budget Fiscal Year 2022
.
https://www.mchd-tx.org/wp-content/uploads/2021/09/MCHD-Adopted-FY-2022-B
udget.pdf
Centers for Health Affairs (2020).
Hospital Finance 101
. Neohospitals.org.
file:///Users/kaitlynfox/Downloads/Hospital-Finance-101.pdf