Service Documentation Monthly Journal Source: The Academy of Healthcare Revenue
Enhancing the Role of HIM Staff in Revenue Cycle Management
January, 2007 –The revenue cycle is a complex and interconnected process that involves multiple departments and staff members. In order for the healthcare revenue cycle to function properly, all staff members and departments must fulfill their responsibilities to ensure that patients are accurately billed for services and reimbursements are obtained from payers. Revenue cycle management has largely been the province of department leaders; however, best-performing facilities have also realized the importance of conducting revenue cycle educational efforts for staff members. Educating HIM staff members of their facilities’ revenue cycle processes can provide staff with a more complete picture of their individual role in the entire revenue cycle process and an understanding of how their actions affect the performance of those further downstream.
HIM staff members play a vital role in the revenue cycle in ensuring that all physician documentation is accurately coded for reimbursement. A recent study of the level of HIM staff participation in revenue cycle initiatives at best-performing facilities found that HIM leaders and staff members typically had a high level of involvement in the revenue cycle. To differentiate between best-performing facilities and average performers, the study collected benchmarking data for days in A/R and discharged-not-final-billed (DNFB) accounts, as these metrics are significantly impacted by coding staff performance. The study found that average DNFB and days in A/R was significantly lower at best-performing facilities.
Among some of the findings of the study, best-performing facilities were more likely to have highly-qualified and experienced coders, employ document imaging support, and have a high level of clinical staff involvement in developing and maintaining coding policies. Interestingly, best-performing organizations were less likely to utilize newsletters to communicate coding guidelines and policies to physicians.1 Instead, direct communication with clinical staff members about coding requirements proved much more effective in obtaining appropriate clinical documentation of patient encounters.
In order to ensure a high level of clinical and HIM staff participation in revenue cycle management and improvement activities, consider some of the following suggestions.2
Cross-Departmental Meetings. Some facilities maintain formal cross-departmental meetings designed to address revenue cycle management concerns. These meetings should include all department leaders involved in the revenue cycle as well as clinical staff leaders. This can be an effective way to HIM leaders to learn about all aspects of the revenue cycle and inform other departments of the needs of coding staff to improve their processes. In addition, conducting frequent informal meetings between HIM and business office leaders can be an effective way for leaders to identify and develop strategies for improving processes affecting both departments, such as how billing information is transferred between departments.
Coding Standards. Setting clear guidelines for coding quality is vital to ensure that maximum reimbursements are obtained. Tracking and sharing individual coding staff and overall coding department performance is also essential for maintaining high coding standards. Utilize performance data in HIM staff meetings to brainstorm solutions and identify targets for staff educational efforts.
Ongoing Staff Member Training. Best-performing facilities educate HIM staff members about all components of the revenue cycle management process. Providing educational courses about these processes, whether conducted internally by hospital leaders or through an external source (e.g., online), can greatly increase HIM staff members’ understanding of their contribution to the revenue cycle.
Effective Recruitment. Since qualified and experienced coding staff members can be very difficult to recruit, HIM leaders should employ range of strategies to attract new coding staff members. Partnering with local community colleges can be an effective method to recruit coding staff. Other methods can include competitive compensation benefits, flexible scheduling, on-site day care for young working families, explicit career paths for internal staff members, and more.
1 Margret Amatayakul, “Benchmarking RCM: Best Practices to Enhance the HIM Role in Revenue, “ Journal of AHIMA, March 2006.
2 Ibid.
The Academy of Healthcare Revenue
The Academy of Healthcare Revenue is a membership-based community that provides healthcare leaders with objective research focused specifically on the healthcare revenue cycle. Members receive an unlimited supply of all research--including benchmarking and best practice reports, implementation tools, monthly journals, attendance to virtual conferences, and more--designed to enable them to improve their revenue cycle processes and financial health from within. Furthermore, The Academy's membership offering is tailored to team members throughout the revenue cycle, from executive leadership to patient access, coding, billing and collections, and clinical staff, helping to drive process improvement efforts revenue cycle-wide. Service Documentation Monthlyis one of four journals written by The Academy of Healthcare Revenue monthly.
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