Assignment: Revenue Cycle Workflow

Assignment: Revenue Cycle Workflow

Assignment: Revenue Cycle Workflow

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Inherent in the Revenue Cycle workflows is the need to collaborate with other departments to ensure performance benchmarks are met and the ultimate goal of timely and accurate cash flow is attained. In this activity, you will identify which departments need to work together to resolve the situation presented in several scenarios.

To complete this assignment, do the following:

Download the scenarios below.

Beneath each scenario, identify the department(s) involved from the list below and explain each department’s role in resolving the issue.

Patient Access/Admissions
HIMs
Coding
Patient Accounts/Billing
Chargemaster Management
Accounts Receivable
CDI
Utilization Management
Clinical Services (Providers, Radiology, Nursing, and other Ancillary Services)
Administration

The healthcare revenue cycle has many moving parts. From patient access and registration to medical billing and coding, provider organizations of all sizes must achieve revenue cycle efficiency to ensure providers get paid promptly and accurately.

However, achieving revenue cycle efficiency is a major challenge, especially for larger organizations with multiple service locations.

Patient financial responsibility, value-based purchasing, healthcare consumerism, and other major trends are also putting pressure on providers to boost revenue cycle efficiency. Providers rely on more payers and plans than ever for reimbursement, which is also increasingly tied to their clinical and financial performance. Meanwhile, patients are becoming more responsible for care costs.

With operating losses per physician increasing to 17.5 percent of net revenue in 2017, providers must prioritize revenue cycle efficiency to remain financially healthy in the changing healthcare landscape.

Automation is key to streamlining revenue cycle processes and boosting overall productivity and efficiency.

AUTOMATE AND AUTOMATE WISELY

Healthcare and technology go hand-in-hand. Providers use a wide range of technologies every day to deliver innovative care to patients and document patient encounters.

But the revenue cycle is still paper-based for many providers. In 2016, a HIMSS Analytics survey showed that 31 percent still relied on manual processes to manage claim denials. More recently, the Council for Affordable Quality Healthcare (CAQH) found that providers could save $8.5 billion annually by automating key claims management workflows, such as prior authorizations, claim submissions, and claim payment.

Revenue cycle automation will significantly reduce the administrative burden on healthcare professionals, streamline revenue cycle workflows, and decrease human error and labor costs. However, organizations must implementing the right technologies to achieve efficiency.

Most hospitals and health systems in a recent HIMSS Analytics survey reported claim denial and revenue integrity issues stemming from their revenue cycle management technologies. A lack of integration with legacy systems and their EHR created data silos, which was an obstacle for collecting revenue reimbursement.

Provider organizations must invest in revenue cycle management technologies that integrate into established workflows and legacy systems. Otherwise, providers are merely adding another step in an already complex revenue cycle. Organizations must also focus their revenue cycle technology investments on patient access, registration, and other frontend departments to ensure efficiency across the entire revenue cycle.