Support_Services - SupportServicesfor Reimbursement...

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Support Services for  Reimbursement Revenue Cycle Management
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Revenue Cycle Management Revenue Cycle: Revenue is regular income, and the cycle is the regularly repeating set of events that produces it Revenue Cycle Management (RCM): All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue
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RCM Old vs. New Approach OLD Linear and unidirectional Not all areas of RC are  involved Each department is  responsible for its  functions  Promotes hostility  among departments Reactive NEW Multidisciplinary  approach RCM team consists of  representative from all  RC areas Promotes teamwork Promotes education Cyclical and dynamic Easily incorporates  changing market forces Payer trends Regulatory Organizational  strategy Proactive
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Why improve RCM? Decrease payment delays and lost revenue by looking at: Clinical documentation Coding Contract negotiations Chargemaster Inadequate pre-certification/eligibility processes Numerous denials and appeals Improve patient satisfaction Re-work at the end costs more than implementing quality controls throughout Each year the HC industry spends @$26 billion on hospital RCM operations
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Revenue Cycle Management  Team  Major functions of Revenue Cycle Admitting Case Management Charge capture Coding Patient Financial Services Finance Compliance Information Technology Each area should have a representative on the RCM Team
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RCM Team Objectives Identify issues to improve AR Communicate issues with appropriate areas Develop educational material such as a revenue cycle manual Create a map or blueprint on how to bring up new services Review denials and actively discuss the appeal process and success Discuss key performance indicators and measures Coordinate upgrades or updates to all interrelated systems (ICD-9-CM, OCE editor)
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Poor Revenue Management Cost of poor quality 3% reduced Medicare outpatient revenues due to  misuse of modifiers 3% reduced revenues due to inaccurate coding 4% missed revenue due to failed OCE edits 5-19% reduced revenues due to wrong codes on  CDM High compliance risk Increasing volume of denials
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Poor Revenue Management Review of one million claims from 80  hospitals shows: 8-30% error rates were common 70% of hospital administrators  underestimate the problem In claims with errors, 14% resulted in  underpayment or delayed payment
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Poor Revenue Management 56% of claims had coding errors 14% ICD-9-CM 86% HCPCS (79% CDM) 17% charging errors 27% billing errors
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Poor Revenue Management A study by Cap Gemini Ernst and Young  concluded that insufficient revenue cycle 
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This note was uploaded on 05/09/2011 for the course HCA 580 taught by Professor Hazelwood during the Spring '11 term at University of Louisiana at Lafayette.

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Support_Services - SupportServicesfor Reimbursement...

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