managing and improving revenue cycle management€¦ · revenue management life cycle front -end...
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Managing And Improving Revenue Cycle Management
Dr. Shairein AhmedHead of Revenue Cycle
ManagementHealthpoint Hospital
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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 .
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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
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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.
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Thank you!
Dr. Shairein AhmedHead of Revenue Cycle
ManagementHealthpoint Hospital