for this dynamic by selecting RCM technology that allows staff to easily access and comprehend the clinical data they can use to appeal the denial or underpayment.
• Point-of-service collections: Although an organization’s rate of uninsured patients post-healthcare reform is likely to decrease, patient payment responsibility for deductibles will continue to grow as health insurers try to reduce their costs. Ensure the RCM system can off er real-time access to patient insurance eligibility prior to service, off er patient responsibility estimates ahead of time and collect payment via credit card or debit card once payer remittance advice is received.
toward automated maintenance in order to deliver quality care without compromising revenue accuracy. Some key questions every organization should consider to
ensure a clean and accurate chargemaster include: • Are all charges for services rendered accurately captured? • How is accountability assigned, tracked and measured for the revenue cycle performance of each clinical department?
• Does staff have the required information to ensure charges are current, complete and compliant?
• Does your organization have eff ective, automated charge- capture tools in place to capture information effi ciently and accurately across disparate systems?
Michael Najera, VP, professional services, Craneware
Building revenue integrity with charge-data management Today’s hospital and health systems face unprecedented challenges as they work to provide quality care and improve fi nancial performance. Uncertainty about new payment models, coupled with declining reimbursement and increased compliance risk, are putting healthcare organizations under mounting pressure to improve internal operations and fi nd cost-cutting methods to ensure fi nancial stability and achieve operational effi ciency and compliance.
An essential cornerstone of RCM is maintaining an accurate chargemaster, as every transaction goes through the chargemaster before being posted to a patient’s account. Yet many organizations do not even realize they should be performing ongoing chargemaster maintenance. Currently, up to 64 percent of hospitals are still using error-prone manual processes for chargemaster updates, leading to lost revenue and compliance risk. Charge-data errors not only justify delayed or denied payment, but given today’s regulatory landscape, errors can also constitute fraud and abuse. As such, it is necessary that organizations shift away from tedious and often mismanaged manual processes for maintaining the chargemaster and move
Justin Steinman, VP and GM, clinical business solutions, GE Healthcare
Revenue cycle and ICD-10: The big healthcare reform challenge
As meaningful use, shared savings and other initiatives rise to the top of the priority list for provider organizations across the U.S., many are focusing attention on the clinical side of the equation and overlooking the impact of RCM. Healthcare reform presents diverse challenges and needs; sound RCM is critical to not only survive the current healthcare evolution, but to ultimately thrive in the new environment. One area that is aff ecting almost every aspect of revenue cycle
– service delivery, billing, claims processing and reimbursement – is ICD-10. ICD-10 represents an enormous shift and requires signifi cant investments in time, resources and costs. It is a challenge that healthcare organizations must undertake with complex planning and robust technology solutions. T is is critical to ensure a successful ICD-10 transition. As the complexity of ICD-10 increases, providers need smart technology to help drive productivity and effi ciency, including tools such as health claims denial, online repair, tasking and analytics. An advanced EMR/practice-management system or revenue cycle system will also be necessary to improve workfl ows related to the visit and
Revenue cycle top performers: HFMA announces MAP Award winners
The Healthcare Financial Management Association (HFMA) has announced the 2013 winners of the MAP Award for High Performance in Revenue Cycle. The distinction recognizes healthcare organizations that demonstrate excellence across all the MAP Key indi- cators of revenue cycle performance, implementing innovative and effective revenue cycle practices that deliver sustainable financial performance. More than 150 applications were submitted for the 2013 award, which is sponsored by Optum. This year’s winners, which include four hospital systems
and six individual hospitals, will be honored during a special presentation on June 18 at ANI: HFMA’s 2013 National Institute. The event runs June 16-19 in Orlando. Winning hospital systems: Baylor Health Care System, Texas Health Resources, OhioHealth and Spectrum Health System. Winning individual hospitals: Saint Francis Hospital, Geisinger Medical Center, Hoag Memorial Hospital Presbyterian, Centra, Baptist Hospital of Miami and Henry County Health Center.
HEALTH MANAGEMENT TECHNOLOGY June 2013 9
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