“We knew that we had significant opportunity to improve our charge integrity, but to get there we needed a technology that would empower our team by replacing manual processes with automated ones,” said Harriet Johnson, assistant director of revenue integrity at Novant Health. “ZirMed was the ideal partner because its Charge Integrity solution provides strategic insights that enable us to proactively address the root cause of charge capture issues. Both the technology and the team have surpassed our expectations. We’ve seen results even faster than we could have imagined—and are confident that we will see continued results throughout our work together.”
Tackling the charge capture challenge at Novant Health
In an era of razor-thin margins, breakdowns in charge capture are increasingly problematic for providers. According to the HFMA, one to three percent of gross charges are lost due to charge integrity leakage. These errors, such as charges billed for services that differ from documentation, incompatible or even contradictory charges between the hospital and professional claims, or services that were never charged at all, pose threats to reimbursement that are too substantial to overlook. In fact, they are costing health systems millions of dollars.
At Novant Health, a four-state, integrated health network that includes 14 hospitals, the revenue integrity team was keenly aware of the troubling statistics, and that the organization’s legacy charge capture tool was falling short. The legacy system produced massive amounts of data but failed to provide what the revenue integrity team needed most – the pattern and trend information required to expose the root causes of the issues. Without those deeper insights, the team members had to spend hours parsing through data to spot trends on their own.
Another major pain point was false positives, i.e., issues which were generated by system rules that did not apply to Novant Health. The team estimated that 70 to 75 percent of charge issues identified by the prior vendor were false positives rather than actual missing charges.
These challenges led Novant Health to explore new solutions to allow the team navigate a more complex reimbursement environment – and to get paid faster, more completely and with less effort. ZirMed’s innovative offering stood out from the sea of competitors because unlike traditional, legacy solutions that rely on static rules-based engines alone, the company’s state-of-the-art solution combines machine learning and predictive analytics to continuously improve the identification of missing charges, duplicate charges, overcharges and payment variances.
Investing in ZirMed’s advanced solution to realize ROI
ZirMed’s Charge Integrity solution helped Novant Health uncover hidden pockets of recoverable net revenue worth $7.5 million within the first 15 months. It enabled Novant to improve Epic workflow processes, engage clinical teams and make work more satisfying for revenue integrity team members. ZirMed’s Charge Integrity solution also dramatically reduced the costs associated with working on charge issues at Novant by virtually eliminating false positives and streamlining workflows.
“ZirMed is fiercely dedicated to helping our customers realize all of the revenue they have earned,” said Ric Sinclair, vice president of product at ZirMed. “Healthcare organizations are under tremendous pressure right now to improve their financial performance, especially in light of the on-going shifts occurring within both the regulatory and payment landscapes. Helping forward-thinking organizations such as Novant Health to uncover charge capture errors at the source means that we’re solving problems today and preventing them from recurring in the future. That’s what our customers need and what we’re proud to deliver.”
ZirMed helps more than 250 hospitals and health systems, and more than 300,000 providers, to optimize their revenue cycles while also streamlining workflows and increasing operational efficiencies. The company’s comprehensive, analytics-driven, dynamic cloud-based platform enables healthcare organizations to quickly identify, anticipate and avoid – rather than just manage – financial issues in an increasingly complex revenue cycle, helping them secure more of the reimbursement due to them today while easing their transition to value-based care.
To see how ZirMed helps gets providers paid, please visit HFMA booth #1119.
ZirMed Inc. empowers healthcare organizations to optimize revenue with a dynamic end-to-end platform of cloud-based financial performance management solutions—including Claims Management, Charge Integrity, AR Management, Eligibility and Coverage Detection. By combining breakthrough predictive analytics technology with innovative development and the industry’s most advanced transactional network, ZirMed’s award-winning solutions extract actionable insights that improve our clients’ revenue cycles—while streamlining workflows and increasing operating efficiencies. To learn how ZirMed can help your organization boost its financial performance, visit www.ZirMed.com.
Amendola Communications for ZirMed
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