Charge Recovery
Underpayment Recovery
Credit Balance Management

ISSUE:
A multi-billion dollar revenue health system was in the midst of standardizing their CDMs and prices for every service line across all facilities. While that was proving to be a difficult experience, the bigger challenge was determining how they would be able to maintain appropriate usage of the CDM by 5,000+ clinicians and ensure critical revenue was not lost.

SOLUTION:
After failing to internally lead their clinicians to perform manual reconciliations, the health system looked externally at several charge capture products. Upon evaluation it was determined that the traditional products fell short, offering generic 'rule-based' logic which was unable to automatically detect facility-specific trends, anomalies and nuances.

Determined to find an innovative, data-driven approach, the health system turned to Apollo Data Technologies to leverage its predictive analytics and intuitive work-drivers. The Apollo Charge Recovery Solution provided the capabilities to identify basic missing charges, but more importantly, the solution automated the detection of each instance where a practitioner simply forgot to enter a charge. The predictive analytic solution processed every claim at the individual account level and flagged any account having errant missed charges.

RESULTS:
Increased net revenue by 1.24%
Identified missed charges with greater than 90% accuracy
Provided work-drivers to validate flagged claims
Highlighted anomalies in charge practices between facilities