Increasing Reimbursement through performing Healthcare Revenue Cycle “Effectiveness” Reviews
Today we will be discussing revenue cycle reviews, specifically revenue cycle “effectiveness reviews." Healthcare facilities face multiple issues that may adversely impact and/or delay reimbursement including budgetary constraints and staffing shortages. Revenue Cycle is defined by HFMA (Healthcare Financial Management Association) as “All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.”
It is common for revenue cycle reviews or assessments to provide metrics comparing key measures against national benchmarks. Although, this data is critical for organizations to know, measuring the effectiveness of your revenue cycle operation and implementing changes will most often result in additional reimbursement and/or reduced delays in reimbursement.
For optimal reimbursement, existing documentation should be reviewed and updated and processes with no documentation should be documented and updated annually or when regulations and/or processes are changed. Process steps in workflow that do not contribute to the organization’s reimbursement, quality, and compliance initiatives, and other defined organization initiative(s) should be eliminated. These steps are similar to what is done during Lean training initiatives where waste in processes is eliminated in process steps.
Monitoring effectiveness of handoffs between the Front-End, Mid-Cycle, and Back-End revenue cycle areas and fully understanding both the manual and electronic workflows within and between these areas is key to success. Lags in workflow between these areas do cause delays and/or loss of reimbursement and often affect productivity of staff.
Systems, software and bolt-on software applications should be reviewed to ensure they are functioning as intended and to their full potential. Updates to current regulations need to be completed timely. Interfaces should be tested to ensure they are working properly. Reimbursement loss and/or delay and staff productivity is reduced when staff perform tasks that are intended to be automated. Management needs to insure that staff are properly trained on primary and bolt-on systems and that training material is provided for reference. Optimal success is dependent upon fully understanding the capabilities of your existing and available technology.
Performing a preliminary Revenue Cycle Effectiveness Review will allow your organization to identify areas in which your organization needs the most updating and focus. After the initial review, your organization can determine which areas need detailed walk-throughs of processes. Effectiveness Reviews when incorporated into your organization’s culture provide increased value and ongoing improvement bringing a continuous improvement methodology to your revenue cycle management operations.
Revenue Cycle Effectiveness Reviews can be performed internally or with assistance from external sources. For additional information about these processes please contact:
Joanne Waters, FHFMA - Senior Director, Revenue Cycle
