Monday Memo  

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Monday, April 22, 2013
  Clinical Accuracy Spoken Here  

Hospital Revenue Cycle:
Optimize Reimbursements

Would you like to:

  • Improve denial management & optimize payer reimbursements
  • Reduce variances in patient treatment plans & reduce avoidable delays

Then we have the course for you. The hospital revenue cycle course discusses the realities of money in our industry, money in our hospital and money awareness for the individual case manager.

[Reference: Hospital Revenue Cycle]

  Excellence in Case Mgmt  

Hospital Revenue Cycle:
Five Forces of Change

  1. Economic downturn
  2. Changes in government regulations
  3. Quality and safety initiatives
  4. Increased consumerism
  5. Information technology

Although the impact is different for payers, they still face the very same issues as the hospital.

[Reference: Hospital Revenue Cycle, Module A, Industry Cash Flow]

  Improving Patient Care...  

Hospital Revenue Cycle:
CMs Work the Revenue

Case managers play a critical role in the functioning of today's hospital because they work the revenue side.

Like any business, a hospital must generate revenues higher than expenses in order to keep the doors open. Case managers submit claims to payers in order to generate revenues. Clinical team members order tests and services (UM) to support clinical care of the patient. The difference between revenue and expense is the hospital margin.

Understanding the hospital revenue cycle will help case managers step up to new and challenging roles.

[Reference: Hospital Revenue Cycle, Module B, Hospital Cash Flow]


Tom RasmussenTom Rasmussen
Athena Forum


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Cathy WrightCathy Wright, BSN, RN
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