Best Revenue Cycle Service Provider

Strategy:

In December 2022, one of Pena4's largest clients, a large NYC health system, endured a debilitating cyberattack, halting its entire technological infrastructure across three hospitals. This disruption paralyzed operations, forcing the healthcare organization to manually document all cases, causing an extensive backlog in medical coding and billing processes. Amid this crisis, Pena4 developed a remote medical coding solution to help this organization revive its operations and overcome the aftermath of the cyberattack.

Challenge Faced:

• Ransomware Attack All of the NYC-based organization's three hospitals were incapacitated, rendering all systems across every facility inoperable for over a week, followed by a prolonged period of restricted access to external systems for approximately a month and a half.
• Manual Documentation The cyberattack forced the healthcare facilities to resort to paper-based documentation, leading to a substantial backlog in medical coding, billing, and financial distress due to halted revenue streams.
• Complex Case Load The backlog comprised intricately detailed handwritten medical records, including complex patient cases with an average length of stay of 13 days, posing a significant challenge for accurate and timely coding.
• Time-Barred Deadlines Beyond sheer documentation volume, the threat of time-barred deadlines added immense pressure to the situation. The inability to process cases within specified deadlines would result in revenue loss for the organization, intensifying the urgency to swiftly address the backlog and ensure compliance with critical billing timelines.

Pena4's Strategic Solution:

In response to the crisis, Pena4 swiftly mobilized a team of approximately 30 dedicated medical coders. They exhibited unwavering commitment, working overtime to expedite the coding process. The strategy included meticulous planning, daily meetings for updates, and a focused approach to ensure rapid progress in medical coding.

Results:

Despite the immense challenges posed by the handwritten documentation and the complexity of cases, Pena4's team successfully coded all 26,421 medical records within the required timeframe. The team invested a total of 7,011 hours to meticulously analyze and convert the manual records into digital format for billing purposes. Pena4's efficient coding ensured compliance with time-barred deadlines, preventing revenue loss for the healthcare organization.

Other Key Performance Indicators:

• Average Length of Stay (ALOS): 13 Days
• Case Mix Index (CMI): 1.7398
• Total Charges Processed: Over $101,260,619

Teamwork

The partnership between Pena4 and this NYC health system stands as a testament to resilience in the face of a crisis. By leveraging expertise, dedication, and strategic planning, Pena4 effectively addressed the challenges arising from the cyberattack, ensuring the seamless restoration of medical coding operations. The successful resolution of this crisis highlights the importance of preparedness, adaptability, and collaborative efforts in safeguarding critical healthcare systems against unforeseen challenges.