Enterprise Revenue Cycle Management for the HI Professional
As healthcare systems continue to acquire hospitals, ambulatory centers, and professional provider organizations, they also seek to achieve economies of scale by combining like-functions such as revenue cycle operations. Implementation of enterprise practice management systems and health records can be a common catalyst for this organizational change. HIM managers can see this as a challenge or an opportunity.
The addition of professional coding into the HIM team offers managers several strategic opportunities to revolutionize the department in the following ways: utilizing professional and facility outpatient coders to assign charges and codes to encounters with both a professional and facility charge with a single touch; streamlining physician education and building stronger relationships with physicians through a single, unified message which encompasses the needs of the facility and professional coding worlds; leveraging the clinical knowledge of CDI professionals by expanding CDI programs to outpatient services and preparing for HCC coding.
HIM Directors may not be familiar with the needs and management of professional coding and physician organizations when they are added to the enterprise. Potential pain points include comfort level with facility charging and DRG, interfacing with physician organizations and with compliance professionals whose main focus is professional e/m services. Additional challenges include achieving a single, consistent, credible physician message for inpatient coding, inpatient and outpatient CDI, and professional fee coding, as well as determining which services are best "hard coded" vs. "soft coded."
Healthcare organizations should explore ways to maximize resources and leverage electronic tools for accurate charge capture and coding. Rather than using an evolutionary approach to organizational design, HIM professionals can be revolutionary and anticipate the needs of the organization before these changes occur so that they demonstrate value and vision for the enterprise. HIM departments will remain a fertile ground of critical thinkers who bring value to the organization regardless of placement.
Attendees of this session will gain strategies for:
• Organizational transformation.
• Resource optimization.
• Revolutionary approaches to revenue cycle management.
Elizabeth Morgenroth, CPC
Culbert Healthcare Solutions Lawrence, KS
Suzanne Layne, MLD, RHIT
Health Information Management, Main Line Health System Broomall, PA
Jeannie Ruch, RHIA, CPMA, CPC
Coding Assessments, RevCycle+ Overland Park, KS