Medicare Risk Business Services

Colorado’s “small team with the big impact” has surpassed even its own expectations, reporting an additional $7 million in Medicare reimbursements last year. That brings the total capture to $10.3 million for Medicare Advantage visits in 2010.

The Medicare Risk Business Services unit—made up of five auditors, a data analyst and a manager—is in charge of auditing all inpatient Medicare Advantage charts to make sure the agency is billed correctly.

Two years ago, a technical issue with Kaiser Permanente’s partner hospitals in the region resulted in incomplete physician signatures on patient charts—which prevented KP from submitting the bills for hospital stays and procedures to Medicare for reimbursement. The error was corrected, but the team had to review 26,000 hospital inpatient notes for that year.

When it first began correcting the error, the unit-based team predicted collecting an additional $2 million to $3 million for 2010 and team members are pleased that their efforts netted KP an additional $7 million.

“It amazes me what the UBT is able to harness and have such great outcomes,” says management co-lead Treska Francis.

The department has worked through the backlog and is now able to submit bills to Medicare within 10 days of a patient’s discharge.

The small team attributes its ongoing success to:

• quick huddles
• holding each other accountable
• transparent communication

“On a daily basis, we know what needs to be completed for the day, (we) set a goal and we go for it,” says labor co-lead Stephanie White, a Medicare risk auditor and SEIU Local 105 member.