By Leo John
HIM (health information management) is the most critical process for revenue capture in a healthcare. A well-planned HIM processes can result in significant improvements in the overall performance of the revenue cycle. Many organizations still underestimate the importance of HIM processes, which can lead to a decline in their revenue cycle.
Many facilities across the country have made positive changes to their revenue cycle processes, especially in areas such as patient access and patient financial services (PFS). These improvements generally result from a thorough evaluation of existing practices and a thorough understanding about the changes required. Many facilities fail to implement HIM enhancements despite their best intentions. This means that they are not able to reap the significant revenue cycle benefits of HIM. Too often, HIM is ignored and only a heightened attention on management of the Did Not Final Bill report (DNFB), is the only way to tackle it.
Methods
Health Information Management reinvent will allow for optimal revenue capture, and improve the efficacy, safety, and operational efficiency of the patient record. It will also position HIM to be a proactive driver of revenue cycle.
After assessing current HIM practices and identifying needs, a multidisciplinary environment must be established that covers the entire operational continuum. This requires a reengineering process of all HIM areas to ensure that information is accurately recorded at all stages, from patient access to final billing. It also allows for data to be made available to all who require it.
It is important to ensure that information systems and staff work with the new process. HIM’s contribution is only possible if all information systems are used properly and if there is a need for training or selective hiring.
A system in place will only ensure a healthy revenue cycle management. This can only be achieved and sustained by efficient practices that are continuously monitored and benchmarked of key metrics.
Trends
Healthcare facilities are increasingly realizing the importance of HIM processes and how they can help keep them competitive in today’s market.
The importance of reporting accurate statistics has been heightened by regulatory and national trends in public reporting.
The industry has recognized proactive management and benchmarking against national best practices standards as a key factor in becoming and staying a top-ranked institution for comparison databanks, and pay-for-performance.
Factors Adversely Impacting the Revenue Cycle:
Healthcare facilities need to be aware of a variety of external and internal HIM-related factors that could adversely impact the revenue cycle.
- The Balanced Budget Act can reduce revenues and increase competition in healthcare facilities.
- Fraud and abuse can also lead to reduced revenue.
- Changing Ambulatory Payment Classifications for Outpatient Prospective Payment System facilities (OPPS), can result in limited reimbursements.
- Complex managed care contracts can increase bad credit due to non-reimbursed fees.
- Facilities are also subject to internal pressures, such as inefficient claims processing, rejections/denials, and late payments, which c
- an lead to higher collection costs, rising operational costs, increased workload expectations, and dissimilar information systems that hinder timely access.
How to Overcome the RCM Issues?
A strategy that is focused on long-term solutions to problems is key to re inventing HIM at hospitals. This strategy also includes the development of appropriate policies and procedures that support continuous monitoring and quality improvement.
To be effective, any strategy must address the known issues and measure progress. It must also allow open communication and a balance between people, processes and technology to ensure successful HIM process.
A successful strategy communicates clearly to all employees and outlines how each area will contribute to the overall plan. It is crucial that everyone involved in the new strategy be committed and becomes true stake holders.
A thorough review of all processes is required to identify and fix process problems. Using flow charts to track every process, bottlenecks can be identified and redundant tasks can also be identified. Then, solutions can be found. It is crucial to include all stakeholders in the development of recommendations by creating an inter-disciplinary team.
It is also necessary to assess current technology. This includes evaluating current software releases as well as analysing how systems are used. Additionally, it is important to evaluate maintenance and update procedures, and make appropriate recommendations for resolving any problems.
Employees should be involved in the process from the beginning, helping to create the process and resolving any issues. After the planning and assessment phases are completed, employees should continue to be involved in the reengineered process. This includes their individual roles, as well as understanding the overall strategy and how they fit into it.
Regular meetings between HIM managers, revenue cycle and patient access are some ways to keep communication open between various stakeholders. All staff must receive updates and status reports, even physicians. Pairing employees from different departments is another way to openly communicate. To encourage cooperation and interdepartmental communication, billers and coders can be paired according to account type. A multidisciplinary team should be formed to address long-term problems and deal with new ones as they arise.
Monitoring progress is essential to any HIM initiative’s success. To keep the reengineering process on track, it is important to set realistic goals and establish checkpoints in the early stages. To address problems, it is important to have clearly defined plans that target these areas.
To ensure smooth operations, benchmarking and monitoring should be continued indefinitely. Long-term, setting a baseline and continuously benchmarking selected HIM metrics will position an organization as a top performer. This will improve both internal and external reporting and ultimately lead to a healthier revenue cycle.
These are Some Examples of Appropriate Benchmarks:
A HIM filing backlog less than 2 days
A lower error rate than 4 percent is required for assignment of duplicate medical records numbers
Coding is completed in less than three days following patient discharge (may vary depending on whether the facility is inpatient or outpatient).
Routine outpatients without missing diagnosis: 5 percent or less result.
Reengineered HIM processes that are based on shared goals and constant monitoring of established benchmarks can provide a variety of qualitative and quantitative benefits that will ultimately improve an organization’s bottom line as well as boost competitive advantage. The well streamlining Healthcare Revenue Cycle Management can strike this out for your organization.
Quantitative benefits include accelerating cash collection by 50% or more and reducing days that claims are still in receivable. A newfound efficiency can also increase the number “clean” claims and reduce denials by 10-50 percent. It can also decrease bad debt by 5- 25 percent. HIM reengineering is a great way to increase resource utilization by up to 25-30 percent.
A well-executed HIM reengineering will improve communication and help staff members understand their roles and responsibilities. A clear definition of responsibilities and careful implementation will result in increased accountability and better performance. Staff and physicians are often happier when they have clear roles and responsibilities. They also feel more involved and efficient.
HIM reengineering can also bring a greater emphasis on value-added tasks which can lead to improved operational infrastructures and efficiency. HIM integration in the overall revenue cycle management can also be a benefit to a facility over time.
All of these qualitative advantages can lead to better healthcare facilities and patient satisfaction. This will ultimately improve your competitive advantage.
Conclusion
HIM is becoming a key driver in the revenue cycle process as industry recognition grows. It will be more important for Health Information Management ’s territory than its current focus on assembly, analysis and chart tracking.
These traditional MRD operations have been affected by technology developments such as the presidential mandate to migrate to electronic medical records (EMR) and the drive towards computerized physician order entry, CPOE. Healthcare facilities must create a culture of managing success by eliminating the environment of managing survival and creating a climate that allows them to manage to thrive. This is done by acknowledging HIM’s role in the revenue cycle, and taking advantage of it.
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