Regional Hospital: Received $4 Million Benefit

The problem

A regional hospital was experiencing financial strain, with a significant portion of its revenue not being realized. Despite providing comprehensive care to patients, the hospital noticed discrepancies in the revenue received from insurance companies. Leadership suspected that incorrect billing might be contributing to the shortfall but lacked the expertise to identify and address the issue comprehensively. They turned to Comfort Profit Consulting to investigate the situation.

What we found

During the healthcare billing audit, it was discovered that numerous insurance billing codes were incorrectly assigned. These errors led to substantial underpayments from insurance companies. The audit revealed that many services provided by the hospital were either undercoded or miscoded, resulting in lower reimbursements than the hospital was entitled to receive. The total potential dollar amount discovered was in the $4 million dollar range.

The Comfort Profit solution

To address the issue, we corrected the billing codes and resubmitted the claims to the insurance companies. Additionally, our administration team engaged in proactive lobbying with the insurance companies to recover the unpaid revenue. As a result of these efforts, the hospital successfully received a $4 million revenue injection, significantly alleviating its financial pressures and enabling continued high-quality patient care.

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