HSMN has provided revenue cycle management consulting services for almost 30 years now. Our knowledge and experience are our greatest assets. We welcome you to read through our articles on this page and learn about our consulting approach below. Should you need additional information or have questions, please Call 866-908-4226 or contact us in order to start discussing what we can do for your practice or organization – www.hsmn.com/contact-us.

Revenue Cycle Management Articles and Resources

• Transitioning Medical Staff and Revenue Cycle Management Team Seamlessly
• The HSMN Revenue Cycle Management Success Formula
• Epic Revenue Cycle Consulting and Post Implementation Workflow Analysis
• Structuring Your Revenue Cycle Organization for Successful Outcomes
• Denial Management with Root Cause Analysis
• Physician Value Based Modifier
• Reorganizing the Revenue Cycle Management Team for ICD-10-CM

Revenue Cycle Consulting Services

HSMN has consulted for almost thirty years with the belief that revenue cycle management is only successful when all of its elements are integrated and form a continuum from the physician documentation of the encounter to the clean claim being paid. Now we are in an era when integration of care must be included and reflected in the documentation of the care received by the patient. Our processes and organization are very focused on those issues.

Our process includes identifying gaps in current documentation and coding, creating a management plan with defined roles, using deconstruction methodology to reconstruct every step toward creating a claim, and web-based training for and by the existing medical staff.

HSMN also believes that managing the revenue cycle is a much art as it science much like medicine and that belief infuses all of our work on integration.

• The revenue cycle begins with the medical staff and clinical documentation; we work with the medical staff to find gaps in the current documentation and coding scenario.
• We work with the clinical documentation team and the medical staff to “Deconstruct” or parse current cases to find the gaps.
• The combination of clinical staff (we try to identify Champions) and members of the RCM team work together to reconstruct every step toward creating a claim. We do this by increasing an understanding for both the clinical and administrative team.
• We help to create a management plan with defined roles, suggestions for workflow changes and try to find the gaps in the various systems that feed the final claim.
• We are also now reconstructing cases into ICD-10-CM/PCS in a way that assists the staffs in learning and internalizing the differences between 9 and 10.
• We provide in depth training of all staff on the RCM Team and work closely with the medical staff to integrate the outcome.
• We believe that online training must be available and so we use the “Champions” of the medical staff and RCM Team to create the web based training that can be easily accessed.

HSMN’s REVENUE CYCLE STRATEGY

Health Systems Management Network, Inc. (HSMN) has provided RCM teams and medical staffs with the tools and training needed for successful claims management, decreased claims denial, and significant improvements to overall revenue. HSMN has engaged by many hospitals after the implementation of “Enterprise Wide” systems to implement restructured work flows, roles, and organizational structure managing the revenue cycle management.

HSMN trains and transitions but we don’t use a cookie cutter. No two hospitals or practices are alike. Therefore we work closely with the medical staff and each component of the RCM team to understand culture, values and history so that the transition to a revenue cycle continuum is internalized.

HSMN’s revenue cycle management solutions are not about buying more software but looking closely at every aspect of the revenue cycle.

Initial Data Collection Accuracy

Human beings and organization history have a great impact on the accuracy of data especially, when having an understanding of the basic things such as primary or secondary payor, insurance verification and authorization for the actual procedure being performed. No system can correct the fundamental errors nor can they code or provide the appropriate clinical documentation that assures the claims will be cleaner.

Too often organizations rely on the system to make everything right. So they become hostage to work queues and these create more work and have to be reworked and it denigrates the entire purpose of having revenue cycle management because the work queue process creates silos of data that no one owns. A revenue cycle continuum is seamless and has accountability. HSMN works with the medical staff as closely as it does with all of the other elements in order to have clean data, best practice clinical documentation and best practice claims management.

Organizational Structure

Organizations should be shaped according to the goals they must accomplish. Determining volumes allows for understanding staffing needs built upon function. Technology support and workflows follow. HSMN devotes much of its time to understanding the shape and purpose of each structure within the revenue cycle.

Clinical Documentation Management and the Transition to ICD-10-CM

Clinical documentation is the life blood of the revenue cycle and it must reflect accurately what has happened in the patient encounter or procedure. HSMN has developed a strategy of case deconstruction which has been proven very effective. Web based technology is used to help with training the medical staff. Actual cases by clinical discipline are “deconstructed” and then reconstructed in ICD-10-CM/ PCS and the presenters of the reconstructed case are in fact a medical staff member and a lead coder/clinical documentation specialist. These presentations become a web based tool to allow other members of the team and discipline to relate to both the clinical content and the presenter.

Operational Assessments & Management Plan

HSMN provides detailed management plans to carry out the recommendations in our assessments of the revenue cycle for both the hospital side and the physician practice. The management plan encompasses a timeline, task list, and responsible people for accomplishing the task. It also builds in benchmarks by which one can monitor the progress of the implementation and measure the success once it is in place.

Call 866-908-4226 or Contact Us to set up an initial dialogue about how HSMN can help your facility or practice.