How Hospitals Can Identify Billing Gaps & Recover Lost Revenue - Lloyd R. Vaughan, VHC, Inc.
Lloyd R. Vaughan of VHC, Inc., a revenue cycle solution provider company attending the marcus evans National Healthcare CFO Summit Spring 2015, on improving billing processes. Interview with: Lloyd R. Vaughan, Founder, VHC, Inc.
Published on: Mar 3, 2016
Transcripts - How Hospitals Can Identify Billing Gaps & Recover Lost Revenue - Lloyd R. Vaughan, VHC, Inc.
Interview with: Lloyd R. Vaughan,
Founder, VHC, Inc.
“Most hospitals have fairly good billing
practices and feel all their bases are
covered, but in reality there are gaps
that cannot be readily discovered by
hospital staff,” according to Lloyd R.
Vaughan, Founder, VHC, Inc. “There is
pressure to get bills out the door, but if
hospitals identified and rectified billing
errors, they could recover one to three
percent additional revenue,” he adds.
VHC, Inc. is a revenue cycle solution
provider at the marcus evans
National Healthcare CFO Summit
Spring 2015, in Palm Beach, Florida,
What revenue do hospitals lose due
to errors? How could they be
Most mistakes are due to billing errors.
To maximize reimbursement, they need
to look at the billing process and
uncover the source of the errors. Some
level of retrospective review is required
to recapture lost revenue.
How can hospitals better identify
what has been lost due to billing or
They need to review payments received
in comparison to what they should have
received. They must look at the medical
records, charge items, payment terms
in contracts, and identify how much was
actually lost due to billing or payment
In some cases, it is a matter of codes
getting lost in the edit process or errors
in the hospital charge master. For
example, pharmacy items that are set
up with a multiplier of one, when the
correct multiplier is ten.
The next step is to submit an amended
bill to get the claim processed again.
Depending on the payer, this can be a
simple process or may require extensive
dialogue to explain the reasons for the
mistake and negotiate a settlement.
It requires specific skills to understand
how to get a payer to follow through.
What measures would actually help
hospitals avoid future payment
There are a number of things they could
do. One, a charge master review,
making sure the codes are set up
correctly, the correct multipliers are in
place and all the other things that need
to be there to generate a correct bill.
Another is to review the claims edit
process to make sure the correct edits
are in place, they are up to date and
that the procedures for dealing with
them are sound.
In our experience, much of the lost
revenue is due to edits not being
handled correctly when a bill is reviewed
before it is sent to the payer. This often
generates exceptions and requires
manual intervention. If it is not done
correctly, codes can be lost and
therefore a payment understated.
Can this issue be fixed in-house by
In theory, there is no reason why it
cannot be done. The problem is,
hospital resources are typically limited.
The number one priority is to get bills
out the door, which does not leave
much time to identify and fix errors.
Hospital folks do not have the expertise
or resources to complete the process.
Any final words of advice?
Every hospital organization should be
open to the idea of an independent
retrospective review of their billing, and
allow someone from outside to look at
processes and end results. If they are
open to getting an objective review,
gaps will be discovered and they will be
able to improve their processes.
How Hospitals Can Identify Billing Gaps
& Recover Lost Revenue
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About the National Healthcare CFO Summit Spring 2015
The 21st National Healthcare CFO Summit is the premium forum bringing senior
level finance executives and solution providers together. The Summit offers an
intimate environment for a focused discussion of key new drivers shaping the
healthcare industry. Taking place at the Eau Palm Beach Resort & Spa, Palm Beach,
Florida, May 17-19, 2015, the Summit includes presentations on navigating new
regulation, supporting growth through collaboration, managing population health
and achieving operational excellence.
About VHC, Inc.
VHC, Inc. specializes in recovering lost revenue for hospitals. Since 1996 the company has done specialty audits of Medicare,
Medicaid and contracted payers. VHC also provides revenue cycle consulting services, including coding audits, chargemaster
reviews and Business Office cleanup projects. The company has approximately 250 hospital clients.
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