Automated systems can give a hospital a great deal of insight into many aspects of the revenue cycle by providing metrics to monitor the performance of the entire cycle, from beginning to end. It is important to review these metrics concurrently and then conduct retroactive reviews to determine ways to improve the system, according to Valerie Barckhoff, revenue cycle practice leader at Quorum Health Resources.
Concurrent review is crucial because it allows errors to be fixed before claims are sent out, but not all revenue cycle software systems offer this function, Ms. Barckhoff says.
Hospitals should ensure their software either incorporates the function or provides the capability as a bolt-on.
In addition to concurrent review, retroactive review should be carried out by a revenue cycle steering committee composed of directors of the revenue cycle departments as well as clinical leadership, particularly in outpatient settings such as the ED or surgery center, recommends Ms. Barckhoff. The committee should meet regularly, probably on a monthly basis, and review 20-25 key metrics in the following areas:
1. Patient access. How accurate is registration of patients? Reporting errors in real time is important here, because you have the patient right in front of you to provide information. Another metric to look at in this area is percent of scheduled patients who are pre-registered. Pre-registration makes it easier to obtain out-of-pocket payments at the time of visit.
2. Case management. How many hospitalized patients are reviewed within one business day of admission to determine the medical necessity of their stay? This needs to be done as soon as possible to make sure the hospital will be paid.
3. Medical records. How well is the hospital capturing data on complications or co-morbidities? And how many days does it take to code for a particular encounter?
4. Charge capture. Is clinical staff entering tasks, such as blood drawing, into the medical record in a timely manner? This metric measures charges not entered within three days of service.
5. Business office. Metrics include days in accounts receivable and the "first-pass" rate, which measures how many claims go through the billing system without having to opened up and examined due to an edit. The pass-through rate should be above 90 percent. Examine what types of claims have to be opened up and find out the reason. Is there some why the process can be improved?
6. Denials by payors. Separate denials between those involving clinical issues and those involving administrative issues, such as not meeting a deadline for submission. Find out what can be done to prevent denials from occurring.
Learn more about Quorum Health Resources.
Read more about the hospital revenue cycle.
-HFMA Report Outlines Strategies to Improve Healthcare Revenue Cycle
-Top 5 Documentation and Coding Challenges Confronting Hospital Specialty Service Lines
Concurrent review is crucial because it allows errors to be fixed before claims are sent out, but not all revenue cycle software systems offer this function, Ms. Barckhoff says.
Hospitals should ensure their software either incorporates the function or provides the capability as a bolt-on.
In addition to concurrent review, retroactive review should be carried out by a revenue cycle steering committee composed of directors of the revenue cycle departments as well as clinical leadership, particularly in outpatient settings such as the ED or surgery center, recommends Ms. Barckhoff. The committee should meet regularly, probably on a monthly basis, and review 20-25 key metrics in the following areas:
1. Patient access. How accurate is registration of patients? Reporting errors in real time is important here, because you have the patient right in front of you to provide information. Another metric to look at in this area is percent of scheduled patients who are pre-registered. Pre-registration makes it easier to obtain out-of-pocket payments at the time of visit.
2. Case management. How many hospitalized patients are reviewed within one business day of admission to determine the medical necessity of their stay? This needs to be done as soon as possible to make sure the hospital will be paid.
3. Medical records. How well is the hospital capturing data on complications or co-morbidities? And how many days does it take to code for a particular encounter?
4. Charge capture. Is clinical staff entering tasks, such as blood drawing, into the medical record in a timely manner? This metric measures charges not entered within three days of service.
5. Business office. Metrics include days in accounts receivable and the "first-pass" rate, which measures how many claims go through the billing system without having to opened up and examined due to an edit. The pass-through rate should be above 90 percent. Examine what types of claims have to be opened up and find out the reason. Is there some why the process can be improved?
6. Denials by payors. Separate denials between those involving clinical issues and those involving administrative issues, such as not meeting a deadline for submission. Find out what can be done to prevent denials from occurring.
Learn more about Quorum Health Resources.
Read more about the hospital revenue cycle.
-HFMA Report Outlines Strategies to Improve Healthcare Revenue Cycle
-Top 5 Documentation and Coding Challenges Confronting Hospital Specialty Service Lines