Evaluation of a Full Time Respiratory Therapist Auditor on Revenue Generation for a Pediatric Respiratory Care Department

Abstract

Background:

Respiratory Care departments generate revenue. In our pediatric hospital (244-beds, Level 1 Trauma Center, Level IV NICU) respiratory care charges are reviewed post discharge by a non-clinical auditing team for accuracy prior to billing. The post-discharge non-clinical auditing team cannot adjust patient charges if there are errors. Our respiratory care department trailed a respiratory therapist (RT) real-time auditor in 2021, gained approval for a new fulltime (FT) position in 2022, and went live with a FT RT Auditor on 4/9/2023. We aim to review the impact of real time RT auditing on revenue generation within our pediatric respiratory care department.

Methods:

A new respiratory department position was approved 7/12/2022, where an internal RT candidate transitioned into a full time RT auditor role starting 4/9/2023. The internal candidate requirements included a BS degree, RT certification, and impeccable documentation in the EMR. The RT auditor worked 40 hours per week from 5am-1:30pm, Monday- Friday, to be available to both 7a and 7p shifts. Daily duties included chart review, RT, and MD communication relative to errors found, and tracking of quality metrics. IRB approved retrospective financial analysis was completed to assess the impact of a FT RT Auditor during the first 30 days (4/9-5/9).

Results:

The RT auditor reviewed 298 patient charts (30.4%), of which 254 (85.2%) contained errors in documentation related to revenue generation. 44 charts (14.7%) contained documentation errors that were inconsistent with policy standards. 78.7% of errors were able to be corrected in real time with 23.6% corrected by the auditor and 55.1% by the bedside RT. 21.3% of errors were either not corrected (8.6%) or unable to be corrected due to policy (12.7%) 65% of RTs had at least one documentation error. The most common errors (Figure 1) were treatment not billed and medications not documented. Increased revenue from auditor driven adjustments was $292K inclusive of $38K in reversed charges.

Conclusions:

The real-time RT auditor produced increased gross revenue from chart auditing and decreased policy documentation errors. The utility of this position and high benefit of a fully trained RT auditor, raises a potential new career opportunity for respiratory therapists. Further research must be done to assess the impact within the field of respiratory care, especially as billing and reimbursement models change.

Figure 1 details the charge errors found by the RT auditor based on type of occurance.