Revenue Cycle Improvement in Healthcare - Case Study Example

Revenue Cycle Improvement in Healthcare Providers of healthcare services consider every step in their services and that there is no room for erroneous moves concerning the collection of revenues and reimbursements for delivered services. However, revenue integrity is a challenging factor because of the numerous complexities in industrial management (Weissman, Lucas & Epstein 1992). For instance, the traditional approach for patient clinical billing in many organizations happens in isolation from other departments mostly with little coordination (Weissman, Dryfoos & London 1999). As such, the faults in one department may affect the performance of others and the integrity of the entire hospital. Therefore, this manual is a guidance that gives an alternative approach to the management of revenue cycle components. The manual includes the best strategies for managing patients at five stages in the hospitals. For instance, the guide will consider best practices for patient access, charge capture, utilization review, and billing and payment accuracy. Patient-Centered Revenue Cycle This approach puts the patient at the focal point of the process of revenue collection (RHIP 2014). The approach also encourages the hospital staff concerned with the process to build better approaches with the patients. The third element of the approach is an established communication with the patients either in written or orally. The creation of a positive experience for patients within the revenue cycle forms a critical step towards the success of the program. As such, the hospitals should train their staff to meet the customer satisfaction points. For example, the workers should answer questions related to the healthcare marketplace. They should also articulate coverage options and discuss the options available for payments. Lastly, the hospital staff should know when or when not to escalate. Therefore, the hospitals should adopt methods that will make the customer aware of all the billing processes at the hospital. Scheduling and Pre-Registration The existence of a centralized system gives the patients a one-stop chance for a single contact center. It also minimizes the possibilities for errors and missing data. There is an understanding that deficiencies in data systems could result in backlogs clear a patient’s financial records. Best practice hospitals should engage in a number of methods that will realize the efficiency of the revenue cycle. First, the hospitals should have a centralized scheduling for receiving patients. Such a step will help the hospitals to have a precise projection of the types of patients that they receive and the details of their payment abilities. The next step is that the hospitals should then schedule their patients for services. There is also a need that the hospitals design scripts for staff to follow in handling patients. It is also necessary that the hospitals provide the patients with cost estimates at the pre-registration phase. Another inclusion in this stage will be the provision of reminders to the patients as well as an inclusion of discussions concerning their balances at their points of service. The systems will work best if the hospitals involve the relevant IT measures that help in the management process (RHIP 2014). Patient Registrations and Subsequent Admissions The hospital staff should start financial clearance soon after the scheduling of the patient, which should be a minimum of 48 hours before the appointment. Benefits verification should depend on the services to offer as well as the out of pocket obligations. The hospitals should install facilities that use electronic verification processes in the determination of insurance benefits for the patients. The staff concerned with the process should then make accessible to the clinical and business office the information collected. The hospitals should also train their personnel to request quotes for the expected reimbursements pending the planned procedures in addition to coverage data (RHIP 2014). It is necessary that the staff make predeterminations of the possibilities that the services will satisfy the medical necessity. As such, they can utilize electronic aids such as McKesson's InterQual criteria that will reinforce clinical decisions for patient evaluation placement in both inpatient and observation services. The best practice facilities may also use presumptive initiatives in determining patients that qualify for charity care and a prediction of the ability of the patient to pay (RHIP 2014). For this case, the hospitals may utilize pre-collection procedures to help them identify the charity care determinations at the start. Such a move helps to reduce the time that the staff members spend in trying to collect payments at the end of the process. Charge Capture and Coding The staff should engage in clear communication of suspense times to each department and define it in their procedures and policies. For this case, suspense times are the timelines that each clinical department has to make a complaint, corrected and audited charges for services offered. The hospitals should engage in systematic reviews of the charge master as a way of ensuring that they capture all revenue in the correct manner (Dattel 2006). Some of the commonly affected areas include pharmacy and outpatient nursing procedures. The members of nursing and health information management should meet weekly to review the charge capture and documentation procedures. Monitoring Revenue Cycle Data There is a need that the hospitals engage in proper monitoring processes that will improve their performance. Such a process depends on effective management and departmental accountability. For this case, best practice hospitals should hold meetings each week that will review revenue cycle performance. They should also benchmark their performance externally by use of peer hospitals to monitor the trends (Haseley, Robison & Williams 2010). The external benchmarks could also serve as a measure of the performance of the hospitals against national standards. They should also benchmark their performance internally using their best historical levels. Lastly, they should use a dashboard that will manage the goals that the revenue cycle team will set towards efficiency. The monitoring process should entail data on collected cash and the cash percentage of net income. They should also monitor gross receivable accounts, gross accounts receivable days, and the net accounts receivable including the receivable days. The process should also track bad debt and charity’s percentage of the hospitals’ gross charges and denials as the fraction of gross costs. During such procedures, the concerned parties should follow denials that will prevent oversight and monitor them by payer and type, reason, department and percentage of submitted revenue. References Dattel, M. A. (2006). Policy Comment: A Game of Hide and Seek: A Critique of the Free Care System of Non-Profit Hospitals in Massachusetts. J. Health & Biomedical L., 2, 129. Haseley, S., Robison, A., & Williams, R. (2010). Healthcare Revenue integrity Strategies. Retrieved April 7, 2015 from http://www.protiviti.com/en-US/Documents/POV/Healthcare-Revenue-Integrity-Industry-POV-Protiviti.pdf RHIP. (2014). Best Practice Concepts in Revenue Cycle Management. Retrieved April 7, 2015 from https://www.ruralcenter.org/sites/default/files/rhpi/hit-guides/Best%20Practices%20in%20Revenue%20Cycle%20Management.pdf Weissman, J. S., Dryfoos, P., & London, K. (1999). Income levels of bad-debt and free-care patients in Massachusetts hospitals. Health Affairs, 18(4), 156-166. Weissman, J. S., Lukas, C. V. D., & Epstein, A. M. (1992). Bad debt and free care in Massachusetts hospitals. Health Affairs, 11(2), 148-161. Read More