From the January/February issue of HealthCare Business News magazine
This report originally appeared in the February 2011 issue of DOTmed Business News
By John H. (Hank) Duffy
For years the “Holy Grail” of Revenue Cycle Management has been narrowly focused on creating charges and collecting receivables. This was the legacy perspective stemming from the days when a relative did the billing and collection for small physician practices and hospital billing shops folded physician billing into their operations for employed physicians. The practice started getting more sophisticated about 10 years ago (that was when it move from being “billing” to “revenue cycle management”) to include a greater emphasis on coding, payer contract compliance, charge master management, and claims “scrubbing.”
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It was at this point that the revenue cycle was more clearly defined as inclusive of all activities from scheduling the appointment to collecting the last dollar. As the focus on the full process increases, so did the use of tools for eligibility verification, denials management and the role of the front desk in collecting co-pays and open balances.
We are now entering a new phase as electronic health records (EHRs) achieve broader and more effective usage. The systematic access to the clinical encounter and the integration of EHRs with practice management systems are opening new possibilities for realizing more revenue from the clinical encounter, but also providing new revenue sources, which need to be considered part of “revenue cycle management.” These opportunities fall into four broad categories including:
Clinical scrubbing of encounters
Audits of the medical record to assess the extent that encounters are fully documented and that small procedures, consumables, and durable medical equipment are being captured for billing purposes. Physicians often overlook documenting some of their activities and items that can be billed. This will alleviate that problem.
Aggregating clinical data
The clinical data available on an aggregated basis can be substantial through government sponsored programs to encourage participation in registries (an example is New York’s eHeart program which pays primary care physicians to participate in its registries) to clinical trial programs.
Participating in incentive programs
The number of incentive programs is increasing and will continue to do so. Incentives are being offered for medical home participation, PQRI reporting, and in some cases for participating in quality programs. Each of these is a revenue source.