Revenue Cycle Management

The quest for revenue recovery has never been more critical for hospitals. In an environment where every dollar counts, hospitals simply cannot afford mistakes in the revenue cycle management department, and this means particular attention is required in the claims and coding areas. To get it right in claims and coding, organizations need to ensure that their practices and processes are correct, and that they are being correctly implemented across all areas of the organization. In short, they need standards: processes and best practices that are leveraged across the system for the benefit of the entire enterprise.

Today, more than ever, healthcare providers across the board are experiencing a minimum 10 percent rise in their self-pay accounts, accumulating more than 20 percent of overall accounts receivable. Historically, this rise has been fairly gradual and expected. Unlike before, however, there are more impactful forces in the market contributing to this phenomenon. Within the next four years, self-pay patient liability will be one of the leading receivables in healthcare. So what are some of the critical market drivers that are catapulting self-pay to the forefront?

When the Appalachian Regional Healthcare System (ARHS) was formed in 2004, the organization’s vision was to build a regional healthcare system that enhanced quality of life and resulted in healthier individuals. Likewise, Rayanna Moore, BSHM, MSOM, system director of revenue cycle, had a mission when she joined the organization in early 2008.

Market consolidation has left payers with legacies of multiple, disparate systems and inconsistent data sets. Many plans have systems that exist in separate silos for various business functions; the systems are unable to routinely communicate essential data between them. This is evident in claims systems that were not designed to receive clinical information.