June 27, 2011

Billy's World: What In The World Am I Doing Here?

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This is my third article for ICD10monitor, and after the first two I suspect that some of you may be wondering why I’m even a contributor. After all, my entire work history (at least since 1977) has fallen under provider financial responsibilities, and my dominant focus now is Medicare payments. I’ve never worked in health information management (HIM, or “medical records,” its understated former name), and I generally am a useful addition to any room full of HIM professionals. Add to that the fact that I consider ICD-10 to be a monumental bore and perhaps a prime example of the term “necessary evil,” and I can understand why you might question my involvement.

The problem with the notion that I really have nothing of value to say lies in ignoring the synergistic and co-dependent relationships among clinical care professionals, HIM professionals and patient financial services (formerly “business office” or “patient accounting”) professionals. Let’s consider this for a moment as I seek to defend my role.

I ride a “trike:” a Harley-Davidson Ultra Classic with a Roadsmith conversion kit from The Trike Shop in Minnesota. Wait, I think I have a photo somewhere … ah, yes, here it is:

While I readily concede that my trike is little more than a manifestation of one form of mid-life crisis, it does serve to make a key point, to wit:

The one thing that distinguishes a trike from all other forms of transportation are those three round hunks of rubber, steel, aluminum and various other materials on each corner. It’s a funny thing about something with three wheels: if any one of them doesn’t do its job, the vehicle won’t go. That is, it won’t succeed in doing what it’s meant to do.

It’s the same with healthcare finance as practiced in provider settings (hospitals, physician offices, ASCs, ESRD facilities, you name it). If the front wheel represents patient care, the back wheels are HIM and PFS. While it’s true there is no money without good patient care, it’s no less true that HIM significantly impacts the collectible revenues on any given claim, and PFS has to be at the top of its game – all the time – to collect those revenues. My favorite maxim is no less true than when it first was stated: “No Margin, No Mission.” And neither caregivers nor HIM nor PFS can claim they are the most important part of the equation. In fact, the system only works, it only thrives, when all three components of the revenue cycle perform at their best.

While my interest and expertise lie in the area of payments, that simply means that my focus is on the PFS third of this relationship. But I readily embrace the reality that my success depends in large measure on HIM providing the best records and coding possible, and, as always, on the clinicians providing the best possible care. Think of my trike as “the Revenue Cycle.” It’s neither a unicycle nor a bicycle; it’s a tricycle, and it succeeds only because of that distinguishing fact.

Quite simply, it is impossible to separate the three core functions of the revenue cycle and operate on the presumption that one or the other (or the other) is “the most important.”  As a payer watchdog, someone who helps providers identify when they are underpaid by FIs and MACs, I depend on HIM to give me an accurate bill, on patient financial services to collect it and on the clinical care professionals to generate the next day’s revenue. It’s a funny thing about cycles: they repeat. So with every new day the clinicians must do as well as they did the day before, as must the HIM and PFS professionals.

Those of us who live, breathe, succeed and prosper working on the provider side of healthcare are not standing in three corners of a wrestling ring waiting for a fight to begin. Rather we are the three keys to any provider’s long-term financial success: the front wheel (clinicians, leading the way), one rear wheel (HIM, assuring that billing is accurate and timely) and the other rear wheel (PFS, generating the bill, following up with payers and collecting everything to which the provider is entitled).


 

Because we all depend on each other, we also have the right and responsibility to consider each other’s priorities and preferenc­­­­es as we pursue our own. Thus my role is not to be focused on the technical aspects of ICD-10 implementation and conversion; there are many people here who are far more capable in that area than I. Rather, my role is to contribute some small insights into one of the other two-thirds of the ICD-10 milieu: patient financial services (and perhaps to serve as a counterpoint to all the “tech talk”). I also reserve the right to be tongue-in-cheek any time I feel like it.

So let us know if you have a topic you’d like me to address. I have opinions about almost everything!

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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Read 110 times Updated on September 23, 2013
Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.