Revenue enhancement through total quality management/continuous quality improvement (TQM/CQI) in outpatient coding and billing.
To survive and thrive, rural hospitals are seeking enhanced revenues. This study focuses on outpatient laboratory and radiology coding and billing accuracy in a nonrandom sample of seven rural hospitals in a Western state. Information was gathered on (1) procedures incorrectly coded, (2) potential revenue increases from correct coding and billing, (3) barriers to implementing changes, and (4) perceived audit value. The identified major source of potential revenue enhancement was increased fees from private payers. Correct coding and billing to Medicare and Medicaid offered the potential of additional revenue. Participating administrators appreciated the validation of coding and billing practices and identification of potential enhanced revenues. Five of seven hospitals (71.4%) selectively implemented recommended changes. Complete compliance with recommended changes was limited by barriers of tradition, competition, and reimbursement, which must be overcome to realize successful implementation. Joint Commission on Accreditation of Healthcare Organization's (JCAHO) new Total Quality Management/Continuous Quality Improvement (TQM/CQI) emphasis provides an opportunity for revenue enhancement through coding/billing assessments and interdepartmental focus and coordination.
Dwore
R B
RB
College of Health, University of Utah, Salt Lake City 84112, USA.
Murray
B P
BP
Parsons
R J
RJ
Smith
P M
PM
Vorderer
L H
LH
D000573:American Hospital Association; D000720:Ancillary Services, Hospital / Q000191:economics*; D005377:Financial Management, Hospital / Q000592:standards*; D006780:Hospitals, Rural / Q000191:economics*; D007182:Income; D007344:Insurance Claim Reporting / Q000592:standards; D007350:Insurance, Hospitalization; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008330:Management Audit; D008484:Medicaid; D008499:Medical Records / Q000145:classification*; D006278:Medicare; D010350:Patient Credit and Collection / Q000592:standards; D017749:Total Quality Management; D014481:United States