Revenue Cycle is a Team Effort

As healthcare continues its rapid change, the revenue cycle has become more critical to hospital success.  Improving revenue performance at any hospital or health system often requires a change in process and demands a renewed sense of teamwork.  At The Nevill Group, our philosophy is to partner with our clients, providing a team approach to this daunting task.  By helping hospitals analyze and redefine their practices, we have been able to increase their revenue stream, thereby securing jobs and improving the entire patient experience.  Collaboration is the key to boosting both revenue cycle metrics and patient satisfaction.

Aside from providing quality patient care, hospitals must focus on defining business goals.  This can be accomplished by (1) incorporating data collected by information technology systems, (2) involvement by the Marketing Department to communicate with patients effectively and (3) looping in business management and the Health Information Management Department.

In addition, your clinical team- including physicians, nurses, therapy departments, utilization managers and social workers- can make great contributions to help align patient care objectives with hospital system goals.

Hospitals must identify the best candidates to step into the revenue integrity fold, and the only way to do this is to engage a diverse group of employee representatives from all departments.  For example, clinical staff often have little knowledge of payment or collection practices, as many clinicians focus on taking care of patients. However, it is critical to ensure that documentation is meeting regulatory compliance and substantiating the medical necessity of the admission.  By including clinical staff and aligning revenue cycle objectives, each patient encounter can be enriched with enhanced quality of care and improved access.

By evaluating the details of each patient encounter, it is easy to see how intricate the revenue cycle is and to observe how many departments affect this cycle.

Optimization of front-end processes starts in the pre-service registration area.  Financial clearance and obtaining correct insurance information is crucially important.  Once the customer has provided accurate information, it is imperative to use the correct admission status, every time, to avoid unnecessary denials that will create a delay in payment and add preventable costs. After admission, it is equally important to reassess status, making sure the patient continues to meet the proper guidelines and that the length of stay is appropriate.

Once the patient is discharged, it is vital to avoid errors in coding and billing, ensuring that every claim is billed in a timely fashion to avoid delays in payment.  It is essential that hospitals revamp their processes to align with the ever-changing federal regulations, adhering to regulatory compliance every step of the way from admission to post discharge.

There is no “i” in revenue cycle.  Hospitals must clarify and delineate business goals, coordinate efforts among a variety of key departments, including medical staff, and they must consistently gather data and improve their overall analytics to solve problems.  Loss of revenue affects everyone, including the patients.