the following slides are from: healthcare revenue cycle basics med inf 404-0 and are credited to...
TRANSCRIPT
The following slides are from: Healthcare Revenue Cycle Basics
MED INF 404-0 and are credited to Jennifer Andersson
Jennifer Van Dyke
Session #8Revenue Cycle
Information Technology – Hospital Trends
2
Collections
Follow-up
BillingMedical Records
Charge Entry
CUSTOMER SERVICE
INFORMATION SYSTEMS & INFRASTRUCTURE
RegistrationAuthorizationVerification
Scheduling Managed Care
CareCoordi-nation
Remit/Cash
Posting
Inadequate training and
accountability of patient
access personnel
Not being managed with a revenue maximization
and denial avoidance mentality
Inadequate insurance and
patient follow-up creates cash flow
difficulties
Billers not retrained to function like
collectors
Information systems personnel
who do not understand patient
accounting
Uncoded backlogs
building up - delayed billings
Inadequate relationships with payors
Bad Information
Rework
Chargemaster not updated to address billing errors and
payor specific requirements
What are the Process Breakdowns?
3
Authorization / Verification• Online and real-time systems to
confirm: eligibility, pre-certification, authorization, verification, referrals.
• Online, real-time, verification of benefit plan coverage and limitations.
• Automatic confirmation of insurance information and expected out-of-pocket contributions.
Charge Entry• Integration of order and
charge entry (no dual entry), including edits for completeness and accurateness of billing information.
Billing• Real-time billing integrated
with collection upon patient checkout.
• Predicted collectability of individual bills.
• Edit for claim accuracy & completeness prior to posting.
Collections/Follow-up• Prioritize collection based
on amount and ability to pay.
Remittance / Cash Posting• Online payment via credit card.
• Automatic re-submission of denied claims.
• Real-time claim adjudication.
Scheduling/Registration• Multiple schedule & registration entry
points.
• Common front-end for registration and scheduling.
• Integration with authorization & verification process. I.e. Gather necessary insurance and demographic information at the point of entry.
• Automated appointment confirmation.
Customer Service (call center)
• Tracking system to categorize correspondence in order to create automation tools.
• New telephony system to reduce response times.
Future Revenue Cycle Technology Vision
Collections
Follow-up
BillingMedical Records
Charge Entry
CUSTOMER SERVICE
INFORMATION SYSTEMS & INFRASTRUCTURE
RegistrationAuthorizationVerification
Scheduling Managed Care
CareCoordi-nation
Remit/Cash
Posting