In the last decade, revenue cycle management has become the buzz word and inadvertently, the substitute for using critical thinking skills when it comes to the flow of revenue through the hospitals or physician practices. HSMN ensures that the integrity of the cycle is maintained and that all phases include optimization.
The Revenue Cycle has existed since the beginning of time. HSMN’s Chief Financial officer describes it as a “continuum of clinical data, demographic and financial information which is then integrated through a manual or automated process before flowing through a billing system to become a claim for reimbursement and ultimately revenue.” What is so complicated about that idea? The problem has been that many of the processes that come together to become the claim have often been done in silos, both in the physician office and the hospital.
The patient, the patient encounter with the physician, the data collected at the encounter, the clinical data merged with the billing information have always been seen as discreet functions and treated as such. Now, it is imperative to use common sense and remember that these functions must be integrated because they are part of each other. Without demographic data the physician doesn’t have a patient. Without documentation of an encounter there is no basis for a claim, and without the transformation of the clinical data into a language that tells the third party payers what they are paying for, there is no revenue. See the cycle?
HSMN has assisted healthcare organizations for over 27 years in priming themselves for optimum revenue cycle performance. Physicians often describe these components, not as an integrated and symbiotic relationship, but rather as the “front desk” person or the “biller.” These components must be seen as a continuum that is the lifeblood of practice.
The creation of revenue cycle mangers or vice presidents for revenue cycle operations is the acknowledgement that all of these functions must be managed in an integrated fashion under one roof (administration). This has been a very good thing for the healthcare providers but unless there is attention paid to the quality of the outcomes of the constituent parts of the cycle there will always be problems in making it work smoothly. A chain is only as strong as its weakest link.
The real secret is to constantly assess each part and to make absolutely certain that the cycle is complete or closed. It has been suggested that each organization develop a metric for working part of the cycle to determine both quality and timing. HSMN help healthcare organization with establishing these key metrics. Even in the solo practice of medicine there is plenty of room to see the continuum of the cycle.