TeraMatch® at Work for a Hospital Holding Company
Situation:
A large hospital system purchases several hospitals in the counties surrounding various metropolitan hospitals it already
owns. The goal is to expand its market into rapidly developing suburbs and exurbs. The hospital system has more than 1 million admissions
per year in 123 facilities with more than $1.4 billion in revenue. It accepts more than 100 insurance carriers, including Medicare and
Medicaid. Each regional area within the hospital system has distinct billing, patient data, and medical records systems. Current information
systems being used do not allow for accurately tracking records.
Protocols:
The new hospitals each have distinct billing, patient data and medical record systems. Each of the facilities maintains
hundreds of thousands of bills and tens of thousands of patient data records, which include insurance coverage and medical record
information. Attemps to combine the data uncovered data qulaity issues within and between the various record keeping systems, such as
inconsistent data fields and overlapping data records. Further, each insurance carrier interfaces with the hospitals’ system sending electonic
files of payments to be reconciled with the billing data. Currently, managers and executives must review reports from multiple data sources
for billing and insurance to understand fiscal, operational, and compliance functions. To produce an integrated, high quality, comprehensive
data view, a business analyst spends five hours developing report requirements with the end user and five hours translating the requirements
for the database administrator (DBA). The DBA requires twenty hours for programming and testing the query results and then another ten
hours pulling the results from the database. The data is then compiled into an excel report and provided to the end user. The overall product
is an integrated report requiring more than 40 person-hours of labor that results in a snap shot of information in an isolated spreadsheet. If
the resultant data stimulates additional questions requiring further detail, the complete process must be repeated to address those questions.
Challenge:
The chain of hospitals owned by one company needs to aggregate billing, patient information, and record management
across all facilites to support a streamlined approach to accurately matching records through integration of muliple repositories of
information. Each hospital may be losing significant revenue as a result of billing inaccuracies due to miscoding, incorrect patient data, or
incomplete bills. This results in a loss of revenue for the larger company, which owns the network of hospitals. The challenge is to aggregate
the data in real-time with high quality and turn it into actionable information that enables the hospital system to resolve business problems
such as billing inaccuracies while also increasing volume.
Solution:
S3 gathered data from IT, finance, and accounting personnel from each hospital. The data were from 3 ERP systems,
6 PC/ client databases, and 2 spreadsheets. After profiling the data and obtaining data translations for four of the databases, S3 loaded and
normalized the data in its format, then TeraMatched it to obtain automated matches and exceptions. Compared with traditional matching
techniques, TeraMatch® matched nearly 40% more records. The matches and exceptions were stored in a reference database located in
Austin, TX. To present the data over the Web, the hospital had the option of using its business intelligence application or having it presented
by S3 temporarily. Because the hospital was undergoing an upgrade of its business intelligence application and the executives desired to see
results within a month, it was decided to use the S3 business intelligence portal. The improved data was to be transitioned to the hospital
system‘s business intelligence tools within a few months. Updates from all source databases were provided weekly and reTeraMatched to
maintain the accuracy of the data. Real-time feeds and TeraMatching were deemed unnecessary for this solution.
Benefits:
By using TeraMatch®, the hospital holding company discovered 10,060 bills with inaccuracies resulting in increased
revenue of $10 million in one year. Compared to a historical one-off audit with the similiar quantity of records for the similiar dollar amount, TeraMatch® matched 40% more inaccurate records for an additional 65% cost recovery- in less than two week’s time for the initial
configuration. Because TeraMatch® is configured to maintain the accuracy during the month, one-off historical audits are no longer relevant
as the hospital can now submit disputes during the billing cycle. For hospitals and health care providers en masse, this represents an
advantage of smart technology to increase the efficiency of compliance and reconciliation functions without a significant outlay in capital or
labor. For example, revenue opportunities from all partially paid or denied bills can be identified and corrected within filing deadlines
resulting in more revenue per bill without external auditing costs. Removing the labor time and expense from this scenario allows the
hospital system to focus all staff on the overall goal of providing superior clinical care.
