The revenue hospitals aren’t seeing.

Hospitals are digging deep to make ends meet yet don’t see revenue opportunities right in front of their eyes. With a simple change of perspective, hospital CEOs and CFOs can increase revenue.

Hospital revenue has taken a real beating. 

Ever since COVID hit, hospitals have been swimming against the tide trying to make ends meet. The first hit was the loss of elective surgeries in 2020. Two years later, elective surgeries are pulling in revenue again, but COVID fallout lingers in the form of nurse costs and staff shortages. Travel nurses are still needed and their costs are still extremely high, if not as astronomically so as during the worst of the pandemic. 

The high salaries paid to travel nurses are causing staff nurses to quit, only to return as higher-paid travel nurses. Even when new staff nurses are hired, there is still the high cost of turnover. “Gerard Brogan Jr., MD, senior vice president and chief revenue officer of Northwell Health, says he has found high turnover is a revenue cycle labor ‘stealth cost,’ as new hires take time to find, train and get up to the speed of existing employees.”*

As a result, hospitals are in penny-pinching mode, trying to rake back dollars and cents wherever they can. 

Hospital ORs and ERs are losing out on millions of dollars in missed charges.

The first response of most hospital executives as they watch their bottom line grow increasingly red is to cut back on costs. What is unnecessary? What can we stop doing? What can we combine or change to reduce the cost? Yet the answer is often less to be found in what hospitals can cut than in what they can find.

Most hospitals are sitting on millions of dollars in missed revenue that they aren’t even aware of. It is often enough to help rural and critical access hospitals stay afloat and, at minimum, can relieve some of the pressure, even on larger hospitals. 

The millions don’t require doing additional procedures. They don’t require bringing in more patients. All they require is a thorough review of the hospital revenue cycle process. 

By bringing in a clinical perspective, your hospital can recover missed charges in the OR and ER.

When hospitals set up their charges and levels, they are often relying too much on what they’ve done historically. This means that anything overlooked once will continue to be overlooked. The revenue cycle team will be able to take this information and create a strong workflow from it. But they will never be able to see what was left out initially.  

To see that, you need a clinical perspective, which is not the skill set of a revenue cycle team. Yet it is this perspective that can tell you where charges have been overlooked and where levels are ignoring the complexity of patient care. By arming your revenue cycle team with a clinical perspective, you will uncover numerous procedures that are not being charged appropriately. These are charges that payers will accept but only if they are presented to them. 

You can increase hospital revenue. 

When a hospital finds these missed charges, they can immediately start bringing in more revenue. Even better, this extra revenue will continue to be brought in every time they perform that given treatment. By using a clinical perspective, hospitals can see what their revenue cycle team is not designed to look for – and make a significant and ongoing impact on their bottom line.

* Daly, Rich, (October 1, 2019). Hospitals Innovate to Control Labor Costs, Health Finance Management Association.

Photo by Giorgio Trovato on Unsplash.

Missed Opportunities

The Hospital CEO and CFO Guide to Recovering OR and ER Charges

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