The hospital revenue cycle management involves clinical decisions, regulations/contracts and billing/finance. To help connect the dots between these areas while improving efficiency, it is crucial that organizations know the appropriate utilization management metrics to track, said Marilyn Palmer, DO, senior vice president of client performance and revenue integrity for RCM company Versalus Health.
Dr. Palmer said in her experience, “most hospitals are not tracking metrics that will ensure all efforts expensed through utilization review are being appropriately captured in the hospital revenue cycle.”
She stated, “Moving away from old generic metrics to monitoring new specific metrics can take the utilization management department from good to great, while significantly impacting hospital revenue and patient engagement."
Dr. Palmer recommended that hospitals consider replacing some old utilization management metrics and replacing them with ones that better address clinical revenue cycle issues.
For instance, she said, instead of tracking overall observation rates, organizations could track the "long stay" observation rate, the number of observation cases with stays greater than two midnights over the total number of cases (inpatient or observation) with greater than two midnights.
If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.
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