How one hospital solved underbilling in 4.2% of urology cases
Customer Stories
How one hospital solved underbilling in 4.2% of urology cases
~$25k in Additional reimbursement
Hospital Statistics
Employees:
> 10,000
Hospital beds:
> 1,500
Location:
US-based Academic Medical Center
The Challenge
The operating room is the profit sanctuary of a health system. But with increasing costs and reimbursement stagnant (at best), the need to optimize for accurate billing reimbursement is growing.
The urology department within a US-based academic medical center leveraged Theator to evaluate if surgical operative reports were optimized for billing reimbursement. Discrepancies were found in 4.2% of urology cases (including prostate, bladder, and kidney surgery) where additional reimbursement should have been captured, but the detail required to support increased reimbursement was not documented in the operative report.
The Outcome
The most commonly missed code for increased reimbursement was Modifier 22, which could have been included in 3% of cases, but was not initially reported from the existing written operative report. The additional detailed needed to support Modifier 22 along with other missed details in operative reports was automatically identified, captured, and written in Theator’s AI-generated operative report.
In total, $24,300 of additional reimbursement can be captured using Theator’s AI-generated, video-based operative reports. AI-generated, video-based operative reports provide a highly accurate description of what happened in surgery and includes the written language necessary to support optimal coding for reimbursement.
