5-hospital Arizona health system boosts collections by recovering $459k in lost revenue and improves processes to prevent future underpayments

Overview

Our client is a 5-hospital health system located in Arizona that began experiencing significant underpayments on a very expensive antibody therapy medication. The health system engaged Titan’s Zero Balance Audit Team to rapidly diagnose and resolve a critical and expanding underpayment problem.

The Challenge

The underpayments had been happening for 3 months before Titan discovered the problem and brought it to the attention of the health system. Titan was presented with two requests: the first – identify the scale of the suspected underpayment problem and recover the lost revenue quickly. The second – identify the root cause and then determine the remedy needed to prevent the problem from continuing.

The Solution

Titan discovered that a new HCPCS code for the antibody therapy medication had been implemented by the AMA effective January 1, 2019. When the health system loaded the new code into their Charge Description Master (CDM), an error had been made in the billing units – the new code was set to bill 1 unit for each 100mg of the medication rather than 1 unit for each 10mg of the medication.

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An audit identified approximately 50 underpaid accounts. Titan alerted the health system as to which payors were affected – specifically those that had paid at a per unit rate. Titan then advised the health system to update their CDM with the correct billing units (1 unit for each 10mg and NOT 1 unit for each 100mg.)

The Results