Challenge
A 14-hospital Midwest health system was struggling with inconsistent Medicare bad debt (MBD) identification and reporting processes. The health system staff was undertrained on MBD complexities and best practices were not established.
Solution
R1 Medicare Bad Debt processed six years of data from each of the 14 hospitals. MBD accounts were compared with Centers for Medicare and Medicaid Services (CMS) regulation, and Medicare deductible and coinsurance amounts were reconciled. Statistical sampling, detailed testing and compilation of final MBD listings were provided to the health system.
Audit support of MBD listings to withstand Medicare Administrative Contractor (MAC) scrutiny was provided by R1’s expert auditing team. Continuous improvements were made that included ongoing education for health system staff and establishment of best practices.
Results
Reviewing six years of data identified an additional MBD reimbursement of $7 million. The health system was so satisfied with these results, it now has R1 completing prospective filings on an annual basis and providing ongoing support for MAC audits.
Financial
$7M
year 1 revenue recovered
Operational
99.5%
acceptance rate of findings
