Erlösverlust durch nicht erfasste MBS‑Leistungen

Definition

In Australia, medical coding and charge capture must correctly reflect all billable services against MBS, ACHI/ACS and private health fund contracts. Revenue‑cycle providers note that incomplete or inaccurate coding causes delays and denials, and they explicitly market services to ensure MBS item usage and procedure codes are optimised and fully compliant so that “nothing slips through the cracks”, indicating common under‑billing in hospitals.[4][7] Outsourced clinical coding auditors in Australia and New Zealand offer revenue‑assurance and Activity Based Funding optimisation because documentation and coding inaccuracy leads to missed funding and underpayment.[3] International RCM literature on charge capture stresses that if services are not captured accurately and promptly, they are never billed and result in direct revenue leakage.[1][2][5] Applying typical RCM benchmarks, hospitals commonly lose around 1–3 % of billable revenue through under‑coding and uncaptured services in manual processes, which, for a hospital with AUD 100m in annual billable revenue, equates to AUD 1–3m per year.

Why This Matters

The Pitch: Australian 🇦🇺 hospitals waste geschätzt 1–3 % ihres abrechenbaren Umsatzes durch nicht erfasste oder falsch zugeordnete MBS‑Leistungen im Coding- und Charge‑Capture‑Prozess. Automation der Leistungsdokumentation, MBS‑Item‑Prüfung und Schnittstellen zum Billing eliminiert diesen Verlust.

Affected Stakeholders

Health Information Manager, Clinical Coder, Revenue Cycle Manager, Director of Finance/CFO, Billing Team Lead, Clinical Department Heads

Related Business Risks