Case Histories

REVENUE CYCLE MANAGEMENT
For a large Midwest academic Medical Center with complex organizational issues, HSMN did a detailed review of every aspect of the Revenue Cycle Management, including but not limited to:

• Reviewed the Operations of Admitting, registration, HIM (Medical Records), clinical data (coding and documentation) management, billing, follow-up and collections.
• Rounded with physicians and shadowed nurses to learn about practice values and documentation issues.
• Prepared an analysis of data to determine appropriate service levels, documentation, coding and billing.
• Studied the roles and responsibilities throughout the organization to determine and locate accountability and vulnerability
• Worked side by side with staff in each of the Revenue Management Cycle areas to facilitate improvements to processes, set goals for performance improvement and create an environment for reconciling differences between front-end and back-end issues.
• Profoundly impacted how Systems were used and how data flowed among and between divisions.
• Finally, HSMN facilitated the implementation of the Management Plan.

Outcomes:

• Designed and implemented a new Organizational structure to manage the Revenue Cycle
• New roles assigned with performance standards
• Ongoing monitoring of all processes in place to ensure continued movement toward agreed upon goals
• From a performance vantage point, the following was achieved.
  • Significant reductions in denied claims for a variety of reasons, including incorrect diagnoses.
  • Significant decrease in Medical Necessity denials.
  • Significant improvement to Cash Flow because of reduction in bill hold time.
  • Net Revenue Improvements based upon work done on the documentation and Charge Description.