PYA Analytics Tools for Healthcare Revenue Cycle Issues

This case study outlines how PYA Analytics Tools were utilized to address revenue cycle issues faced by a midsize community health system following the transition to a new electronic medical record (EMR) and billing system. The study details the initial assessment conducted by PYA, which involved analyzing patient transaction data from both the legacy and new systems to identify discrepancies in gross charges and net reimbursement. It explains that the conversion led to a nearly 20% decrease in gross charges, primarily due to changes in charging methods and supply chain setups. The findings revealed that certain departmental charges were understated, and adjustments were necessary to align the new system with historical charge levels. The case study also presents recommendations for updating the chargemaster and emphasizes the importance of ongoing monitoring to ensure revenue levels are maintained. Overall, the document serves as a comprehensive examination of the challenges and solutions related to healthcare revenue management during system transitions.