Health Systems Management Network, Inc. (HSMN) in its 27 years of operation has often found that both Hospitals and large Medical Practices, especially Faculty practices, have found that sometimes the installation of new Systems has changed their Revenue Outcomes. Why is the AR climbing? Why are we realizing fewer dollars from our patient encounters?
Despite the amazing technology, it is still the Organizational Structure that is the major determinant in Revenue Cycle success. The “Systems” cannot fix bad processes, employees who aren’t skilled enough for their jobs, lack of training, failure to adjust workflows and just sloppy handling of data. These are fixable with the correct assessment. HSMN with major input from its clients has developed a program called ReMAP (Revenue Management Assessment Program). In it a grade is assigned after the assessment tool is used to analyze each and every segment of the Revenue Cycle: Registration, Scheduling, Clinical Documentation, Clinical Records, Billing, Claims Management, and Denial Management. Each of these is reviewed with a view to finding the gaps in the continuity, integrity, quality and productivity as well as quality of staff performance.
Once the Assessment is complete, work begins with each group within the Revenue Cycle including its Managers to better understand the history and transition of each of the workflows and each of the roles within the Cycle, their design and purpose post “System” implementation.
HSMN counts heavily on the input from the existing staff including the Medical staff. We interview Medical staff, discuss cases especially ones that have been denied to determine where the breakdown in communication is. Since ICD-10-CM is perched to arrive next year, we work toward helping all staff involved to improve their functioning. For the Medical staff we work with them in “Deconstructing Cases” in the current ICD-9-CM and work to improve those documentation requirements and then move those cases in simulated fashion to ICD-10-CM so that we are challenging what goes on with the current to prepare for the future. We work with all of the players so that Coders, Billers, Registrars and Schedulers are looking at the same cases to see what needs to be fixed as the “claim” moves through the entire cycle.
We search carefully for how data are transmitted from system to system to final claim. Once the process is finished we recommend an Organizational Structure with defined roles based on the specific financial goals of the institution and outline the skill sets and training essential for success. The HSMN Tool ReMAP is then turned over to the Revenue Manager(s) for them to monitor outcomes and continue to make improvements.
In 27 years we have been very successful with a long and deep list of Health Care providers whether they are Health Systems or Clinical Practices for significant improvements to their gross and net Revenue.
Call us 866-908-4226 or email us firstname.lastname@example.org for a conversation about the issues that most concern your organization or practice.