The proactive error identification and correction provided automatically by Monarch Data Pump has yielded compelling financial benefits to Baptist Health. "After Monarch Data Pump was implemented at Baptist Health, accounts on the Failed Bill Report [billing that cannot be sent out due to missing or erroneous patient information] declined by 75%! This helps Baptist Health's accounts receivable days remain as low as possible, accelerating cash posting from reimbursement for services provided."

John Moody is a healthcare consultant and Interim Charge Capture/Charge Description Manager for Baptist Health, a non-profit healthcare system located in Montgomery, AL. John has over 24 years experience in the healthcare industry including 5 years experience in revenue cycle management. John's mission at Baptist Health and his other healthcare clients are to ensure their Charge Description Masters (CDMs) correctly describe the services provided, comply with all regulations, and fulfill payer requirements. He also develops processes to assure all charges for clinical services are captured accurately and timely for proper billing.

These goals are critical for any healthcare organization, because errors in the charge capture process will cause erroneous billings, payer rejections, long delays in payments and possibly lost revenue. John avidly uses and recommends Monarch and Monarch Data Pump to deliver automated, customized charge data throughout the healthcare organization, complete with analytics, to quickly identify possible errors.

Monarch is Datawatch Corporation's desktop report mining tool, transforming existing reports into live, actionable data for easy analysis, export to Excel and more. Monarch Data Pump goes even further as a server solution providing automatic report/data mining and customized data delivery for the entire organization.

John uses Monarch Data Pump to automatically mine and delivers customized charge data, sourced from a variety of healthcare reports. "Baptist Health runs the McKesson STAR patient accounting system," says John, "but other healthcare patient accounting systems, such as McKesson Health Quest, SMS [Siemens Healthcare], Meditech and others, offer a library of reports containing the needed data which Monarch Data Pump can easily get at."

Typically, a CDM manager will spend a lot of time briefing clinical managers on changes in charge descriptions and/or codes, validating that the codes currently being used continue to match the service the facility is actually providing. CDMs may have 10,000-40,000 lines of charge items. Before the government's implementation of the Hospital Outpatient Prospective Payment System (HOPPS) in August, 2000, hospitals updated coding in their CDMs annually and rarely did an indepth review to assure all services were being captured. With the implementation of Ambulatory Payment Classification (APC) codes, hospitals that do not maintain accurate up-to-date CDMs with the latest coding changes risk leaving significant new reimbursement opportunities unrealized. They further risk the incorrect use of revised or deleted codes resulting in lost reimbursement or receipt of improper payments that must be returned to the payer.

Coding changes for APC codes typically occur quarterly with the possibility of technical corrections each month. The process to validate the implementation of required coding changes would be tedious and time consuming without the data extraction capabilities of Monarch, and automated information delivery using Monarch Data Pump.

John uses Monarch Data Pump to mine data from charge reports, and filter the data to display charges posted to new charge description codes, to see if the new codes are being used properly. "If this step in the billing process is wrong, the final patient bill will be wrong," John says. "The worst case billing scenario for a healthcare organization is if a patient is billed for the wrong services. It is a very labor-intensive and expensive process to make the necessary corrections.

"Monarch Data Pump provides effective tools to avoid costly charge capture errors by enabling proactive charge reconciliation and ensuring charge items and their associated codes are being used correctly right now."

Another highly successful Monarch Data Pump project automatically reconciles Baptist Health's charge data from its three hospitals with its general ledger data. John's Monarch Data Pump process consists of automatically mining data from twelve different charge reports, and loading customized data into an Access database. This data is then compared with data mined from the general ledgers. Finally, Monarch Data Pump delivers customized, reconciled charge data for all 68 revenue departments to over 100 recipients throughout the organization. "Managers now know right away if a charge did not make it into the billing system and can take corrective action immediately," says John.

John has taken the power of Monarch Data Pump even further, by automatically searching for exception data mined from charge reports. John explains, "I have Monarch Data Pump look for obvious charge errors, such as incorrect service quantity or date of service entries that are clearly data entry errors. Plus, Monarch Data Pump compares current charges for all 68 revenue departments with historical data for each department. If the current day's charge data is different from the department's historical run rate by more than 5%, the data is filtered and presented for further review. Here too, Monarch Data Pump flags potential errors early in the charge process to correct now, instead of much later, perhaps after an erroneous bill has been issued and rejected."

In still another successful project, Monarch Data Pump automatically delivers data mined from patient reports to the Patient Access & Registration department, to identify charge errors and correct them before the patient is discharged. "The charge errors are sent to the correct clerks for correction," says John. "They commented this was the first time they ever had their work organized for them so well. Error correction is now much easier and faster."

The proactive error identification and correction provided automatically by Monarch Data Pump has yielded compelling financial benefits to Baptist Health.

"After Monarch Data Pump was implemented at Baptist Health," John says, "Accounts on the Failed Bill Report [billing that cannot be sent out due to missing or erroneous patient information] declined by 75%! This helps Baptist Health's accounts receivable days remain as low as possible accelerating cash posting from reimbursement for services provided.

"The contribution margin for healthcare services, especially for a non-profit healthcare organization, is quite small," John adds. "Healthcare organizations must ensure that the correct service charges are posted to the correct charge descriptions."

Monarch Data Pump for Healthcare: Baptist Health Takes Charge of its Charge Process (PDF)