NQS Activate 360™ identifies $6.6 Million in unbilled trauma charges for a Southwest hospital system

The Challenge

A hospital system in the Southwest needed assurance that the charges it records for trauma care were actually reaching payers. Trauma Registry Team Activation charges are a significant source of revenue, but the facility had no way to confirm they were included on submitted claims.

The hospital system did not have a reconciliation process to verify that Trauma Registry Team Activation charges appeared on the claim submitted to the payer. Without that check, charges documented in the Trauma Registry could be missed at billing, and the facility had no visibility into how much revenue was being lost.

The Solution

The facility implemented NQS Activate360, software that reconciles the Trauma Registry against the 837 (claim) file. Activate360 compared the two data sources and produced a list of charges that were documented but never billed. The facility was then able to rebill those charges and capture potential revenue that would otherwise have been lost.

The Results

Activate360™ discovered charges missing from submitted claims over a 12-month period, a gap that had gone undetected before reconciliation was in place.