Physician Critical Thinking and “The Machine”

computer-158675_1280Congratulations to all of those physicians who proved that physician diagnostic accuracy is much better than the diagnosis created from an app. There is nothing better than a live clinical critical thinker for the medical decision making process so critical to Quality Care and reimbursement regarding the clinical setting. This is the beginning that fuels the engine of any successful revenue cycle improvement program.

Health Systems Management Network, Inc has worked with physicians in every clinical discipline in every setting and found that our experience supports the recent study done at Harvard. Therefore, we have advised our clients that the Revenue Cycle begins with the medical staff surrounded by a team of consultants who also use critical thinking skills. The clinical context in which the physician is working matters. Therefore, in addition to the wonderful academic training coders and billers receive there has to be another dimension: Accountability. Now that ICD-10 is here to stay and flexibility is now gone for mistakes made in clinical documentation or coding/billing, we are working with our clients to see the revenue cycle team with physicians as team leaders and coders/billers as their consultants.

Most important of all is that non physician revenue cycle staff must understand the context, culture and practice of the clinical discipline in which they are working. You can bet you are going to have a correct diagnosis and related procedure from the physician, but you may not always have continuity with the ICD-10 system.

So the Revenue Cycle team needs to be close to the action, advise medical staff and provide services while the at the same time physicians also provide info to the coders and other members of the RCT. Frankly, the ICD-10 from a procedure perspective has to be built and therefore critical thinking skills must be present.

The study at Harvard (well done) illuminates the brilliance of the clinical mind in making a diagnosis; it is based upon training, experience, data, and patient presentation. From now on when you think of the Revenue Cycle team think Captain MD. And work toward building bridges from the clinical decision making to the coding necessary to receive the appropriate reimbursement.

HSMN has had success in using such models for significant improvements to the revenue flow and net revenue. All us or reach us through our website for a chat about how we can help. After 30 years doing precisely this work, we have learned a great deal from the clinicians with whom we have worked and have put such knowledge into our practice.