Revenue Cycle - ICD10monitor

As a former manager of clinical documentation integrity (CDI) and utilization review (UR) at an academic medical center, my focus was on understanding all possible sources of revenue leakage. At that time, the UR staff focused on activities that demonstrated a patient’s medical necessity, as defined by a variety of…
Unnoticed and under-reported is the clinical revenue cycle (CRC). In my experience, the clinical revenue cycle (CRC) is seldom mentioned and under-reported. The more universally recognized concept, of course, is revenue cycle management (RCM). It is the umbrella of which CRC is an integral part and a crucial revenue driver,…
COVID-19 has added another level of complexity to the revenue cycle.  Hospitals and health systems need to update their current revenue cycle processes, becoming more efficient in that arena. Revenue cycle must eliminate inefficient processes in order to drive revenue preservation that translates into optimal net patient revenue. These changes…
The CDI profession has failed to effectively articulate its value in the revenue cycle. Role-based versus task-based business processes can play a major role in driving operational performance of any department or organization. From a business perspective, each department of a company or firm contributes to the overall success and…
Mid-revenue cycle is becoming increasingly important for driving financial stability. How do you define revenue cycle management (RCM)? Have you clearly delineated what is included in the front, middle, and back of RCM for your facility? You must do so before you can appropriately address the resource requirements for each…
Big ICD-10 changes coming soon to the SNF world. In July 2018, the Centers for Medicare & Medicaid Services (CMS) finalized a new case-mix classification model, the Patient-Driven Payment Model (PDPM), which, effective beginning Oct. 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS)…
How to enhance edits to achieve clean claims. The effective use of edits within a healthcare organization’s billing system may permit such organizations to not only identify documentation, billing, and coding issues to address, but also facilitate achieving an improved clean claim rate. A clean claim is one that meets…
HIM professionals touch many functions of the revenue cycle. As we continue this segment on health information management (HIM) in the revenue cycle, I’d like to share some thoughts I discussed at the recent Missouri Health Information Management meeting. When we think about the functions that compose the revenue cycle…
Pursuing revenue cycle roles could be an ideal path for HIM professionals. Often, we see patient financial services staff progress to leadership positions in the revenue cycle. When I have the opportunity to serve in such positions, I always wonder why we don’t see more health information professionals in these…
Not billing the APP service can result in serious revenue cycle errors. Many providers are still struggling with the non-physician practitioner (NPP) billing rules from the Centers for Medicare & Medicaid Services (CMS). Most facilities are now referring to NPPs as Advanced Practitioner Professionals or APPs. I get questions all…