Increasing Revenue Through Enhanced Billing Practices

Summary

Impact Statement: 
Through several PDCA cycles, the Madison County Health Department was able to increase revenue from billable service fees in two program areas -- one by 13% and the other by 16%. The process improvements gradually will be applied to all direct service program areas, followed by other improvements to further enhance revenue.
Summary: 

The initial aim statement for this quality improvement (QI) project was as follows: "Develop an enhanced and efficient patient process that will maximize revenue by November 2012."

The initiative was chosen to reduce burden on the county for the provision of health services by increasing revenue from billable health services that were not effectively captured. A backlog of re-billing of denied claims represented a significant dollar amount from the prior 12 months. The health department had only begun the billing process 3–4 years prior and did not have trained or experienced billing experts on staff. The benefits from this project were that staff have realized increased revenue from billable services in two programs and that staff have developed a more reliable billing process. Intangible benefits include heightened awareness of process and QI methods, and billing staff are more aware of how errors affect the overall process and contribute to claim denials. All staff are more aware of how the patient flow process has points along the way where missed information affects the billing process, such as registration and obtaining correct patient information. This process has helped the health department in its search for an electronic health record (EHR) application to focus on reports that will enable staff to have QI projects driven by data.

Organization that conducted the QI initiative: 
Madison County Health Department
Citation: 

Shepard, J. Public Health Quality Improvement Exchange. Increasing Revenue Through Enhanced Billing Practices. Fri, 02/24/2017 - 14:50. Available at https://www.phqix.org/content/increasing-revenue-through-enhanced-billing-practices. Accessed February 25, 2018.

Submission Status: 
Completed
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