Session #8 Revenue Cycle Information Technology – Hospital Trends

1. The following slides are from: Healthcare Revenue Cycle BasicsMED INF 404-0 and are credited to Jennifer AnderssonJennifer Van Dyke Session #8 Revenue Cycle Information Technology – Hospital Trends

2. CUSTOMER SERVICE Care Coordi- nation Remit/ Cash Posting Registration Authorization Verification Scheduling Collections Follow-up Managed Care Charge Entry Medical Records Billing INFORMATION SYSTEMS & INFRASTRUCTURE What are the Process Breakdowns? Inadequate training and accountability of patient access personnel Not being managed with a revenue maximization and denial avoidance mentality Uncoded backlogs building up - delayed billings Inadequate relationships with payors Bad Information Inadequate insurance and patient follow-up creates cash flow difficulties Rework Information systems personnel who do not understand patient accounting Billers not retrained to function like collectors Chargemaster not updated to address billing errors and payor specific requirements

3. CUSTOMER SERVICE Care Coordi- nation Remit/ Cash Posting Registration Authorization Verification Scheduling Collections Follow-up Managed Care Charge Entry Medical Records Billing INFORMATION SYSTEMS & INFRASTRUCTURE Future Revenue Cycle Technology Vision • Scheduling/Registration • Multiple schedule & registration entry points. • Common front-end for registration and scheduling. • Integration with authorization & verification process. I.e. Gather necessary insurance and demographic information at the point of entry. • Automated appointment confirmation. • Billing • Real-time billing integrated with collection upon patient checkout. • Predicted collectability of individual bills. • Edit for claim accuracy & completeness prior to posting. • Remittance / Cash Posting • Online payment via credit card. • Automatic re-submission of denied claims. • Real-time claim adjudication. • Charge Entry • Integration of order and charge entry (no dual entry), including edits for completeness and accurateness of billing information. • Collections/Follow-up • Prioritize collection based on amount and ability to pay. • Authorization / Verification • Online and real-time systems to confirm: eligibility, pre-certification, authorization, verification, referrals. • Online, real-time, verification of benefit plan coverage and limitations. • Automatic confirmation of insurance information and expected out-of-pocket contributions. • Customer Service (call center) • Tracking system to categorize correspondence in order to create automation tools. • New telephony system to reduce response times.