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Case Study

Compliance function serves as trusted business partner and helps colleagues verify their coding and procedures are up-to-date

Executive Summary

When two hospital systems merged, the Compliance function struggled to keep up with cumbersome exsiting processes. This was on top of another complex problem facing the hospital system: billing headaches.

The health system needed a better way to handle rejected and improperly coded bills, and in turn, improve overall revenue collection. And the Compliance function needed a system for verifying the right people were taking the right steps to accurately code bills.

Implementing YouCompli gave the Compliance function a reliable way to capture metrics, compile analytics, produce reports, and verify the rights steps were taken to comply. This elevated the Compliance function from the “department of no” to a strategic business partner.

Read how YouCompli empowered the Compliance function to verify the organization was doing what it needed to do to comply and deliver greater value.

The Challenge

Merging two large health systems is a complicated and cumbersome process. As the organization tries to accommodate rapid growth, it can also face additional risk – including regulatory risk.

When an East Coast hospital system merged with a cross-town health system, the Compliance func- tion struggled to keep up with merger challenges. This was on top of another complex problem facing the hospital system: billing headaches.

The health system needed a better way to handle rejected and improperly coded bills, and in turn, improve overall revenue collection. And the Compliance function needed a system for verifying the right people were taking the right steps to accurately code bills.

But the Compliance team only had access to software that was part workflow manager, part project manager. The software lacked regulatory analysis, model documents, and metrics.

The existing software package didn’t allow the Compliance function to thoroughly monitor regulations to be aware of relevant billing changes. And it didn’t help the Compliance function decide if billing changes were applicable, or manage the rollout and accountability of requirements. Nor did the software help verify the right steps were being taken and completed by required dates to comply.

The Compliance function needed one source to help with the whole process, from monitoring regulations to verifying it was taking the right steps to comply. That’s where YouCompli came in.

The Solution

Coding properly is, obviously, critical to a successfully run hospital system. When bills are coded incorrectly, the organization doesn’t get paid.

Part of the Compliance function’s role, of course, is ensuring that hospital systems are aware of the changing regulations that affect billing codes.

But what if there was another way for a Compliance function to support a hospital system’s billing process?

With YouCompli, there is. YouCompli tools enabled the hospital to connect its Revenue Cycle department’s account managers with its clinical delivery teams.

Specifically, the Revenue Cycle department used YouCompli tools to communicate with clinical delivery staff to verify they’re coding services correctly. Communicating before a service was provided proved critical to ensuring that everyone knew how to accurately code a bill.

This reduced miscoded services and inaccurate bills – leading to fewer claim rejections and payment delays.

YouCompli resources also helped the hospital system manage a new requirement related to prior authorizations for certain procedures. The Revenue Cycle got sufficient notice on a new prior authorization rule that they could communicate with patients about procedures scheduled before the requirement took effect, but that were subject to the prior authorization rule.

YouCompli enabled the Revenue Cycle department to verify prior authorizations for previously sched- uled procedures. This ensured that the hospital system avoided denials for these procedures. Not only was this valuable in verifying compliance, it made a financial impact on the organization.

It’s another way the comprehensive YouCompli solution helped elevate the hospital system’s Compliance function.

The Impact

Healthcare compliance officers often have a tough time demonstrating their function’s value to the larger organization. YouCompli empowered this hospital system’s Compliance function to serve as a strategic business partner and demonstrate its value to business partners.

Before implementing YouCompli, the merged health system’s Compliance function had no idea how many new federal or state regulations were coming in. The compliance officer couldn’t be sure whether new or changing regulations even applied to the hospital system. Nor could the compliance officer verify whether the hospital system had complied with them.

Implementing YouCompli gave the Compliance function a reliable way to capture metrics, compile analytics, and produce reports. YouCompli armed the Compliance function with actionable data to inform hospital leaders of potential risks and other considerations.

This elevated the Compliance function to a strategic business partner, rather than a “department of no.” YouCompli enabled the compliance officer to provide hospital leaders with a complete view of the audit trail, tasks, business requirements, tools, and decision criteria. These resources empowered the Compliance function to better inform colleagues and leaders about the entire regulatory landscape.

The Compliance function also relied on YouCompli to monitor changes – billing-related and otherwise – coming in and verify which people were responsible for demonstrating compliance. YouCompli made it easy to verify completion dates for deliverables and prove how the organization has complied with a change.

And as the hospital system improved its handling of rejected and improperly coded bills, YouCompli helped verify the organization did what was required to comply. Centralizing all compliance resources in one place on YouCompli provided the hospital system with a comprehensive approach to managing regulatory change.

YouCompli gave the Compliance function confidence to serve as a business partner, knowing the right people were informed of relevant regulatory changes. Being able to verify progress and completion by required dates – for billing purposes and other regulations – was crucial to proving the Compliance function’s value. YouCompli provided a powerful way for the Compliance function to deliver greater value to the hospital system.

Find out how you can use YouCompli to verify your organization has made best efforts to respond to regulatory changes appropriately.
YouCompli customers have access to notifications about changes to regulations, resources to inform policy and procedure updates, and tools to track compliance.
VERIFY progress and completion by required dates
Verify healthcare regulatory changes
This reduced miscoded services and inaccurate bills – leading to fewer claim rejections and payment delays. Elevating the Compliance function to a strategic business partner, rather than a “department of no.”
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