managing and improving revenue cycle management€¦ · revenue management life cycle front -end...

Managing And Improving Revenue Cycle Management

Dr. Shairein AhmedHead of Revenue Cycle

ManagementHealthpoint Hospital

Revenue Management Life Cycle

FRONT -END

• Payer negotiation and renegotiation , patient accesses including scheduling , preauthorization , insurance verification , Point-of-service collection and financial counseling.

MIDDLE • Clinical documentation, Change capture, coding, case management .

BACK-END• Claims processing and payment posting , Follow-up, customer service,

collections and denial management .

MEDICAL DOCUMENTATION

PROPER CLAIM PROCESS

FAIR REIMBURSEMENT

Digital Documentation Improvement

The quality of data generated is Increasingly tied to cost efficiency under value-based reimbursement models

Clinical Documentation

• OP: Evaluation and Management Levels Fair reimbursement would be maintained through insuring the correct level of care

• IP: Case Mix Index The CMI of a hospital reflects the diversity, and clinical complexity of IP patients in the hospital.

Thank you!

Dr. Shairein AhmedHead of Revenue Cycle

ManagementHealthpoint Hospital