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By Katie Adams from Becker’s Hospital Review
U.S. hospital margins are remaining narrow, prompting healthcare revenue cycle leaders to examine their processes and make sure no money is falling through the cracks.
Donna Ellenburg, revenue cycle director at Birmingham, Ala.-based Grandview Medical Center, said hospitals can avoid losing revenue by adhering to the following process: verifying insurance benefits prior to a patient’s visit, ensuring there is an authorization for the service if one is necessary, and collecting the patient’s responsibility prior to their arrival or upon arrival.
“Another way to avoid lost revenue is by having a good charge reconciliation process to ensure all charges are posted to a patient account both timely and accurate,” Ms. Ellenburg said.
Michele DeSmet, the director of revenue integrity and Grand Rapids, Mich.-based Spectrum Health, said one of the best defenses against lost revenue is collaboration between the clinical care and revenue cycle teams.
“Revenue is typically generated by the clinical teams who care for patients,” Ms. DeSmet said. “When clinicians understand how their documentation of patient care triggers revenue, they’re better able to identify gaps in revenue and use their expertise to help design process improvements to eliminate revenue variances.”
Ms. DeSmet said that educating nurses and other clinical care teams about how their actions affect the revenue cycle — and by extension, the hospital’s financial performance — helps them better understand how their documentation supports the hospital’s mission and bottom line.