For 27 years Health Systems Management Network, Inc. has worked with various Hospitals, Health Systems and Physician clients to help them optimize their ambulatory care and practice billing. When the Ambulatory Payment Classification (APC) system became the payment methodology, HSMN was among the first firms working to prepare all of its clients to be successful in the new payment scenario.  As Health Systems and Academic Medical Centers strived to build both the technical hospital billing component and the professional fee revenue, HSMN played a pivotal role.

HSMN Inc. is proud to announce that our clients have now requested that we do interim coding and billing on both sides of the equation.  Technology has made it possible for us to code and bill remotely, and more importantly, help our clients monitor the quality of the documentation, the coding interpretation and the purity of the claim. The addition of claim scrubbers has created yet another layer of delay in the billing process and HSMN has worked to clean up the process and reduce the number of claims that do not meet edit standards.

HSMN Inc. has introduced a process that looks at current claims, past and those in process to identify the sources of errors and real opportunities to be compliant while optimizing revenue. Remotely, we monitor all aspects of the revenue cycle and on site, we work with the Medical, Coding and HIMS staff to fashion a “Clean Claims Performance Improvement Project.”  In many cases, the client asks us to take over some of the coding and billing, as well as the monitoring and correcting of rejected claims that have come through the HSMN Root Cause analysis program.  Our clients are reporting a 70% rebill accuracy from what had been a 10-20% success.  Clients have also reported that our coding and billing program has reduced the rejections by 95%.

HSMN would like to hear how others are doing in their efforts to get it right the first time.