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Invest in CM Revenue Cycle Management Training
Inattention to billing and failure to monitor the claims process are listed as two of the top 5 challenges facing hospitals in today's healthcare marketplace, according to a recent article on Revenue Cycle Intelligence.
Inattention to billing and claims processes can hurt hospitals to the tune of tens of millions of dollars, fail to identify billing and coding errors and may also shock patients with huge debts that they cannot pay.
As patients become increasingly responsible for out-of-pocket costs, hospitals will need to ensure that they aren't leaving uncollected revenue on the table or squeezing their patients so hard that they seek care at other facilities the next time they need care.
Case Managers can impact their organizations Revenue Cycle by addressing medical necessity, coding and by having conversations with the patient early on if providers are to reduce the amount of bad debt they're currently experiencing.
Next month, Athena Forum will publish Revenue Cycle Management, a new course with eight modules focused on training CMs to increase core knowledge of revenue cycle management.
Next week, the Monday Memo will address an additional organizational challenge, Health Information Technology and its influence on the Revenue Cycle.
Tips from our featured course
Billing, Revenue Cycle and CM Leaders
The longer it takes to get a discharged patient's bill to the insurance company (called DNFB, discharged but not final billed), the longer it takes to be reimbursed for care already delivered.
Billing leaders monitor denied-claim rates and benchmark them against industry averages.
Revenue cycle leaders look at each area's measurements to harmonize business practices across the revenue cycle and compare the entire revenue cycle relative to peer institutions.
CM leaders also must monitor clinical and financial processes and outcomes, including evaluating the program's impact by benchmarking data to industry standards.
[Sneak Peek: Revenue Cycle Management, Module B, RC Teams]
Impacting Care Delivery and the Bottom Line
"No one disputes the contributions of physicians, nurses and other providers, but very few, if any of these clinicians are responsible for ensuring that patient care is delivered appropriately to every patient and that the healthcare organizations get reimbursed for that care.
"Only case managers are responsible for both of these essential functions. As a result, case managers are making significant contributions to the bottom line in hospitals and other health systems."
Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP
Director of Social Work Education
Athena Forum Institute®
[Sneak Peek: CM Express 2016, Module B, Improving Claims]
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Athena Forum Institute
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