Commonwealth Health Corporation

How three Kentucky hospitals increased revenue by 28 percent


In early 2011, Commonwealth Health Corporation (CHC) conducted an on-site audit of its Evaluation & Management (E&M) level charges, processes and nursing documentation at each of its three emergency department (ED) locations.

At the time of the audit, emergency nurses were handwriting charge sheets to assign the E&M level for patients. However, with 150 nurses at three locations, it was difficult to maintain consistency. The audit’s "starting metric" strongly suggested there was room for improvement.

T-System conducted a detailed review of nursing documentation and provided one-on-one training to ED nurses. T-System also completed a charge master gap analysis and made recommendations for each ED based on the findings.

With T-System’s guidance, CHC was able to quickly streamline its ED documentation and coding processes and achieve notable results in only a few short weeks. For example, T-System had recommended that CHC reassign the task of E&M code assignment to the coding specialist. This move freed nurses to do what they do best – caring for patients. It resulted in:

  • Consistency with nursing documentation
  • Consistency with E&M level assignment among coders
  • Increased revenue at all ED locations as it relates to appropriate E&M assignment
  • Faster feedback to clinicians regarding any missing documentation elements
  • A decrease in data entry by ED registration staff members

A seven-month snapshot comparison of the three EDs’ patient volumes illustrates minimal year-over-year change:

Facility Total ED Visits
(Jan-July 2011)
Total ED Visits
(Jan-July 2012)
Percent Change
   The Medical Center at Scottsville
   The Medical Center at Franklin
   The Medical Center at Bowling Green

However, a seven-month comparison of the three EDs’ improved financial performance from 2011 to 2012 reveals:

Facility Revenue Change
(Jan-July 2011-2012)
   The Medical Center at Scottsville
   The Medical Center at Franklin
   The Medical Center at Bowling Green

The charts above demonstrate the impact clinical documentation and optimized coding processes have on a hospital’s bottom line.

T-System’s chart audit services helped our hospitals get back on track with documentation and coding consistency,” said HIM Director Georgena Brackett. “Each ED in our health system has experienced drastic revenue improvement despite our annual patient volume remaining relatively flat,” Brackett said.

Commonwealth Health Corporation

Location: Kentucky
EDs: 63,200 APV at 3 locations
Hospital Beds: 337
Physicians: 308
Nurses: 741
Coders: 12
T-System Solution: Chart audit services

RevCycle+® Consulting Results:
  • Streamlined documentation and coding processes
  • Increased revenue at all locations
  • Consistency with E&M level assignment
  • Decrease in data entry by registration staff members
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