Revenue cycle upgrades: increase cash flow and lower expenses

Healthcare Financial Management, July, 2005

* What up-front changes were necessary before you could make a major dent in improving revenue cycle performance?

* Hilton: Two years ago, the typical revenue cycle functions were decentralized. Today, my position is accountable for the patient access areas, the typical health information management operations, as well as coding and transcription, the system chargemasters, and all facility billings plus self-pay collections. As a result of our joint efforts, we have been able to reduce our accounts receivable by more than nine days.

Centralizing the management of these functions has given us control over many of the variables that might have been left off the table in another day. We've been able to implement process changes that have eliminated finger-pointing and barriers, specifically in our coding, dictation, and chargemaster areas.

For example, on our inpatient side, our health information management group is responsible for compiling charts and getting them to the coders. In the past, there were delays in getting the charts compiled so the coders could review and do their work. Today, both areas are under one management stream, which has allowed us to implement new processes for getting completed charts to coders faster, thus reducing our discharged-not-final-billed by 20 percent. One example of how our processes have improved is that our evening and nighttime health information management operations staff prep that day's discharges, giving the coders an instant work queue for the next morning.

* Cincotta: From my past experience as a revenue cycle consultant, I have learned that every organization has a different organizational structure. You have to determine what best fits your organization's needs. Our revenue cycle is more decentralized than centralized. We set up standard biweekly revenue cycle meetings that involve admitting, medical records, case management, and patient financial services departments to maintain the flow of communication. This enables us to work as a team to problem-solve and identify solutions to our issues.

We also implemented a front-end and patient financial services training program. We hired an organization to facilitate the training program, which resulted in standardizing education across our organization. The training provided staff with an overview of the revenue cycle and how each person has a direct impact on the revenue cycle. It was an excellent program and let the staff know how valuable they are.

* Did you need to implement any major information system changes?

* Sykes: It is important to have a robust health information system. It is also imperative to optimize the system to drive proven practice workflows. We have leveraged best-in-class "bolt-on" technology to further enhance revenue cycle workflows. A primary example of this is our predictive dialer system, which has significantly increased our productivity, resulting in enhanced call center performance, patient collections, and customer service. Additional bolt-ons that we leverage include document imaging, contract management, denial management, claims editing, and electronic data interchange solutions.