Revenue-cycle redesign: honing the details.
To minimize claim denials and ensure optimum payment for delivered services, many hospitals must fundamentally change their approach to managing the revenue cycle. The revenue cycle should be conceptualized as a continuum rather than as a set of isolated events, such as submitting bills or collecting payment. Cross-functional teams composed of representatives from clinical and financial areas should be created to systematically address recurrent breakdowns detected in the revenue cycle. PFS staff should be better compensated based on their value to revenue-cycle performance and receive adequate training on data collection and billing requirements to ensure the submission of clean claims. Medical-necessity screening software tools should be used at initial patient-access points to help identify scheduled services not covered by Medicare.
LaForge
Richard W
RW
Patient Financial Services, Genesis Medical Center, Davenport, Iowa, USA. rick.laforge@tribridge.com
Tureaud
Johnny S
JS
D000067:Accounts Payable and Receivable; D019985:Benchmarking; D019033:Delivery of Health Care, Integrated / Q000191:economics; D005377:Financial Management, Hospital / Q000379:methods*; D007324:Institutional Management Teams; D007344:Insurance Claim Reporting; D007349:Insurance, Health, Reimbursement; D007484:Iowa; D010350:Patient Credit and Collection; D017749:Total Quality Management; D014481:United States