Tuesday, April 08, 2014

Revenue Cycle Management is not just for hospitals any longer!

 A Health Information Manager's (HIMs) role in the Revenue Cycle Management and the workflow:

The revenue cycle and the management the involvement of a Registered Health Information Management Administrator (RHIA) of the processes contained in a good plan are vital to obtaining accurate reimbursement. Every piece of healthcare information collected during the cycle contributes to the production of an error-free claim. The effective management of the revenue cycle results in efficient processes that meet the Key Performance Indicators identified for your practice and produces optimal performance in accounts receivable management. Achieving and maintaining optimal performance levels at a physician’s practice not only improves revenue but allows the practice to focus on other areas for improved profitability in this every changing healthcare delivery model.

Outcomes of working with a RHIA professional: 
Once a RHIA has worked with a practice they can assist in supporting contract negotiations with commercial payers. With all the data collected in the Key Performance Indicators, the RHIA professional can help your organization work more effectively identify commercial payers with compromised margins and initiate negotiations that better align reimbursement with resources utilized. In addition, the practice will have the ability to better evaluate pricing for commercial payers, based on fee schedules from Medicare and Medicaid, and establish pricing based on desired profit to help steer the negotiation process. Moreover, market share and lives covered will assist in leveraging a better reimbursement model, but most importantly quality measures and data reporting that the RHIA professional can obtain from the system will further support the negotiations. The physician’s practice will now be able to look at such things as case mix, utilization, and outcomes during negotiations with individual commercial payers.

1.      Key Performance Indicators
                                          i.     Practice Operating Margin
1.      Measures financial performance of a physician entity on an accrual basis
                                         ii.     Practice Net Days in Accounts Receivable
1.      Calculates the average number of days it takes to collect payment on services rendered and measures revenue cycle effectiveness and efficiency
                                        iii.     Practice Cash Collection Percentage
1.      Measures revenue cycle efficiency and supports valuation of current accounts receivable and predicts income
                                        iv.     Total Physician Compensation as a Percentage of Net Revenue
1.      Demonstrates ability to afford physician compensation in relation to revenue of the physician enterprise
                                         v.     Professional Services Denial Percentage
1.      Tracks payer denials and impact on cash flow and trends payment and process improvement opportunity
                                        vi.     Point-of-Service (POS) Collection Rate
1.      Provides opportunity to decrease collection costs, accelerate cash flow, and increase collections
                                      vii.     Total Charge Lag Days
1.      Measures charge capture workflow efficiency and identifies delays in cash
                                     viii.     Percentage of Patient Schedule Occupied
1.      Identifies opportunity to maximize slot utilization and improve practice productivity

As you can see, the profession has grown from a Librarian to a key player in the Revenue Cycle Management process. 

Kevin (Michael) Harrington, RHIA is a full time faculty member in the health administration program.

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