As consumerism and price transparency intensify and margins shrink, improving revenue cycle performance likely is at the top of the list for most health care executives. Payment reform is reshaping providers’ relationships with payors and creating new challenges for clinicians, coders and analysts who are working to accurately document care.
As you work to streamline your processes, improve cash flow and decrease denials—all while simultaneously improving your patients’ experiences—consider our top five highlights and related resources:
1. Assess the Current State of Your Revenue Cycle Operations
Due to decreasing reimbursement facing hospitals and ongoing regulatory scrutiny, it’s imperative hospitals and health systems assess their revenue cycle operations and develop a road map to improve financial and operational performance. Meaningful improvement within revenue cycle operations can significantly improve financial performance, enhance technology capabilities, mitigate compliance risk, elevate management performance, increase team morale and strengthen the patient experience.
2. Revisit the Charge Master
As health systems develop strategies to move from volume- to value-based payments, the charge description master (CDM) still is the engine providing power to the transition. Regular CDM maintenance is important to capture an accurate and complete record of the care given. Wondering what key areas to focus on? Read our article “Finding the Value in the Charge Master.”
3. Prepare for Risk-Adjustment Payment Based on HCCs
Providers have historically missed opportunities to assign International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes that accurately reflect documented chronic conditions, thus affecting associated hierarchical condition category (HCC)-mapped risk scores. As the shift to value-based reimbursement continues, now’s the time to begin analyzing existing documentation and coding practices that will directly affect risk-adjusted reimbursement in the future. Read our article “HCC Coding Increasingly Important in Shift Toward Value-Based Reimbursement” to learn how HCCs can affect reimbursement.
4. Concentrate on Coding
Providers have a long history of insufficient clinical documentation and nonspecific or inaccurate assignment of ICD-10-CM diagnosis codes. With the transition to value-based and risk-adjusted payment methodologies, a focus on routine medical record audits, clinical documentation improvement and compliant coding practices will affect almost all areas of quality reporting and ultimately provider reimbursement. For a list of coding tips, read “Understand the Value of Accurate CDI & Coding.”
5. Diagnose Your Value-Based Performance
Understanding how fee-for-service behaviors affect the total cost of care for attributed lives is essential under outcomes-based reimbursement. Knowing internal and external costs (provider payments) will help providers measure and manage outliers. For a deeper dive into payment reform, read “Diagnosing Your Payments: What’s Driving Your Value-Based Reimbursement?”
If revenue cycle performance improvement is back on your priority list in 2018, we hope the resources above help you and your team. If you’re looking to transform your revenue cycle and aren’t sure where to start, or if you have questions about any of the topics above, connect with your trusted BKD advisor.