Our Tried & True Revenue Cycle Management Success Formula

Health Systems Management Network, Inc. is proud to announce our new program called Back to Basics and more. We are elated to inform you that the search for the ultimate revenue cycle management process is over. Our 27 years of experience working with a wide variety of healthcare organizations has allowed us to develop a formula that has significantly improved every aspect of the revenue cycle in all healthcare delivery settings. We have decided to share this formula for success with you.

A process called Cycle Deconstruction is the most critical component of the formula. As the term suggests, all constituents of the revenue cycle must be taken apart and scrutinized.
The clinical documentation must be examined to ensure that it supports the procedure and encounter; often, the medical staff or practice members need a sit down for a discussion; then the case should be taken apart to show the clinicians why it does or does not meet the criteria for payment.

The coder-biller teams should carefully review the claim to ensure that the demographic information, billing and authorization are correct for the procedure performed. We often find that the procedure ordered is not exactly the same one performed in the operating suite. Therefore, the coder-billers must go back to the source of the order and the person placing the order to make sure they really understood the ordered direction. In many organizations the schedulers are not coders and neither are the clinicians and thus these folks need to be part of the retroactive link to correct the claim.

If a denial occurs, then the case needs to be deconstructed among all of the participants in the claims creation. There is no easy way to do this, healthcare organizations often move such claims and records into work queues to track the reworking of the claims. The component parts of the revenue cycle should create a Special Ops Team on which all of the disciplines are represented and take charge of not only fixing the denial but finding its root cause. The denial management with root cause analysis can be the basis for systems, processes, operational education for all those involved.

The revenue cycle sometimes needs a shaking up because of organizational and cultural history. A proven method is to have each one of the department heads within the revenue cycle switch roles for a period of time until each has experience the others’ operational issues.

The revenue cycle is a stream and through it flows revenue; this formula by HSMN keeps the ripples and bends out. For more information about our revenue cycle management strategies please visit call us at 866-908-4226.

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