Helping our clients
save 
millions

Over $240,000 Recovered

Challenge

The formulary data within Cerner Millennium™ is in a constant state of change. Auditing should be done monthly or after every update, but clients don’t have time to manually audit their systems. Therefore, many clients miss key issues in the system, such as missing or incorrect HCPCS codes or QCFs, that result in major revenue loss.

 

Discovery

Using Softek’s Formulary Compliance Control, our consultants found 127 QCF build issues that were leading to missed reimbursements. For the first two months of the year alone, the client was missing $249,218.75 in reimbursements. Our Formulary Compliance Control also identified 2,784 expired NDCs, 366 that were causing Medicare to deny payments. In addition, our tool identified two drugs missing HCPCS codes leading to denials as well.

Results

After the presentation of the findings, the steering committee authorized corrective action be taken to fix the incorrect QCF. Of the 127 found, 113 were corrected. Multum will update the pharmacy formularies with the most recent HCPCS code units of measure provided by CMS.  In this process we discovered that seven drugs had incorrect Multum measures needing to be corrected by Cerner.

Client:

Large Western Hospital

Technology Used:

Panther Formulary Compliance Control

Issues Fixed:

Build and Update Issues

Over $500,000 Recovered

Challenge

The formulary data within Cerner Millennium is in a constant state of change. Auditing should be done monthly or after every update, but clients don’t have time to manually audit their systems. Therefore, many clients miss key issues in the system, such as missing or incorrect HCPCS codes or QCFs, that result in major revenue loss.

 

Discovery

Using Softek’s Formulary Compliance Control, our consultants found 10 reimbursable drugs with QCF issues. In total, these issues caused over $500,000 of missed reimbursement for the client over the prior six months.

Results

In total, we found over $500,000 of missed reimbursement over the last six months. Softek was able to recover the entire $500,000 for the client. The client now uses Softek’s Formulary Compliance Control to monitor for incorrect HCPCS codes or QCFs and correct them before they hit the billing system.

Client:

South Eastern Hospital

When Softek Engaged:

3 years post-EMR conversion

Technology Used:

Panther Formulary Compliance Control

Issues Fixed:

Manual Auditing Process

Over $400,000 Found

Client:

South Eastern Hospital

 

When Softek Engaged:

3 years post-EMR conversion

 

Technology Used:

Panther Charge Integrity Control

 

Issues Fixed:

System Change/Upgrade Issue

 

 

Challenge

Cerner clients can audit charging within their EMR system using reports. However, this is a very manual process and does not uncover all issues. At any point, build and system changes may affect charge activity.

 

Discovery

The client had a system change that led to inconsistencies in charging. Softek’s Charge Integrity Control compares patient orders and corresponding charges along the entire transaction process. Using this control, Softek consultants were able to find $270,000 in missed charges within Radiology over a one-day span. Within Gen Lab alone, there was $143,000 in missed charges.

Results

In total, we found over $400,000 of missed charges over a one-day span. Softek was able to recover the entire $400,000 for the client. The client now uses the Charge Integrity Control and Charge reports daily or weekly to monitor for missed charges and reconcile them within the specific department.

 

$19.2 Million Found

Challenge

One large Southeast Hospital noticed its revenue was millions of dollars less than expected three months following a complete implementation of Cerner Millennium, including Patient Accounting. No one could find what caused the dip and the revenue team was losing trust in the newly implemented EMR system.

 

Discovery

Using the Charge Integrity Control inside our proprietary Panther technology, Softek’s Revenue Consulting team had instant visibility into missing charges. The Control instantly identified nearly $4.8 million in lost revenue that other analysts had missed for three months, including:

 

  • $3.8 million in 16 different orderables in Blood Bank and General Lab that never posted a charge. One lab test was ordered – and not charged – nearly 20,000 times.

  • $1 million in General Lab and Anatomic Pathology orders that sometimes charged, but not always. Our Control showed that all the missing charges came from the same location.

 

By drilling into the data, our Revenue Consulting team discovered that the no-charge orderables were the result of build issues and the inconsistent charging was caused by a workflow design issue.

Results

Correcting the build and workflow issues stopped revenue leakage that would have totaled $19.2 million annually.

Client:

Large Southeast healthcare organization

When Softek Engaged:

3 months post-conversion

Technology Used:

Panther’s Charge Integrity Control

Issues Fixed:

Application build and workflow design

$3 Million Found

Challenge

Revenue at one Southern academic medical center was down six months after going live with Cerner clinical applications. No one could find the source of the drop.

 

Discovery

Softek’s Revenue Consulting team used reports within our Panther Charge Capture technology to quickly locate the source of this six-month-old problem. Among them, the Pharmacy No-Cost Ingredients Report showed 30 days of data and identified 17 pharmacy ingredients that did not have costs defined but were being ordered on a pricing tier that referenced specific costs.

Results

The client corrected its system build to add in costs for these ingredients and allow them to begin charging. The correction of just 17 charge items stopped revenue leakage that would have totaled nearly $3 million annually. The client also manually corrected these charges for the previous 30 days and was able to recover $250,000.

Client:

Southern academic medical center

 

When Softek Engaged:

6 months post-conversion

 

Technology Used:

Panther’s Charge Services Reports

 

Issues Fixed:

Application build

 

 

$2.5 Million Found

Challenge

Revenue at one Midwest regional medical center was down six months after going live with Cerner clinical applications. No one could find the source of the drop.

 

Discovery

Using the Charge Integrity Control inside our proprietary Panther technology, Softek’s Revenue Consulting team had instant visibility into charging gaps within each department. In Radiology, our team noticed that even though all procedures had charges, some were much lower than the expected average price. Drilling into the data revealed that the procedures with low charges were charging inconsistently. The accurate price included two charges, but some orderables were missing their second charge, which was a technical one. Softek identified 10 different orderables with a manual change to the technical tier that had led to this missing technical charge.

Results

The client corrected the build in its technical tier to allow it to post charges. The correction to these 10 orderables stopped revenue leakage that would have totaled nearly $2.5 million annually. The client also manually corrected these orderables for the previous 30 days and was able to recover $206,000.

Client:

Midwest regional medical center

 

When Softek Engaged:

6 months post-conversion

 

Technology Used:

Panther’s Charge Integrity Control

 

Issues Fixed:

Application build

$1 Million Found

Challenge

The charge build for orders at Cerner clients is very complex. Using charge tier logic, clients must determine how to charge for each orderable which can vary by such factors as locations and encounter types. While most clients and consulting companies believe revenue issues stem from the billing side, Softek understands that most mistakes happen well before charges are sent to billing.

 

Discovery

During our engagement at one health system in Florida, we noticed issues related to orders not posting charges and orderables that sometimes posted charges, while other times did not. Softek classifies these as “No Charge” orderables and “Inconsistent” orderables. Inconsistencies like these will never be seen if you are auditing the billing side, but using our Charge Integrity Control, Softek’s Revenue Consulting team had instant visibility into these charging gaps. Our control helped identify which orderables had missed charges and for which patients they were occurring on.

 

With this control, we identified inconsistent charging within the Gen Lab. One orderable was completed 6,374 times in one month but missing a charge 2,923 times.

 

After meeting with the Lab department, it was determined that this orderable was indeed chargeable. Looking further, it appeared that it classified as “inconsistent” because at the beginning of the month it was charging as expected. However, sometime in the middle of month, a change was made, and it was no longer posting charges. These orders were all missed due to a change in the charge point mid-month.

 

Mid-month, the charge point was changed to “Collected” when it should have been “In-Lab.” The In-Lab status is a mandatory status for an order to be completed, but the “Collected” status is one that can be skipped. Because this orderable was not hitting the “Collected” status, it never was posting charges (nor was it suspending).

Results

With all the no charges, the 3,439 orders led to around $84,600 in missing charges in one month and would continue indefinitely until fixed.

 

The Softek Revenue Consulting team and the Panther Charge Integrity Control identified missing charges that would have totaled over $1 million annually.

 

Our consulting team worked with the client and Cerner® to resolve these issues and confirmed the orderable is now posting to date.

Client:

Health System in Florida

 

When Softek Engaged:

2 years post-EMR conversion

Technology Used:

Panther’s Charge Integrity Control

 

Issues Fixed:

Build/Workflow

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Phone: 913.649.1024

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Cerner®, Cerner Millennium®, and Cerner Smart Hospital® are all registered trademarks of Cerner Corporation, or its subsidiaries or divisions, registered in the US and other countries, and Softek makes no claim in or to the same. Cerner Corporation is not affiliated with Softek and does not endorse or sponsor our products or services.