Revenue Cycle Monitoring Tools

1 Revenue Cycle Monitoring Tools The healthcare industry is experiencing a growing challenge associated with rising provider costs, patient debt, and the volatile healthcare market. These challenges have necessitated the establishment of effective revenue management systems. The revenue cycle management (RCM), for instance, is a dynamically evolving system under the value-based approach to care (Harrington, 2019). It is a financial process used in hospitals to track patients' progress from registration, treatment, and payment. The revenue cycle management is used in different settings, including single-doctor family practices and large institutions.

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2 Tools and Techniques for Improving Health Care Finance The electronic health recording system is a powerful tool used in improving healthcare finance. The EHRs gather relevant patient data and provide hospitals with a platform to analyze this data for streamlined coding and billing. The EHRs enable the hospital to track the healthcare services provided to patients for accurate billing (Harrington, 2019). The technology platform ensures that all administrative tasks, including claim processing, scheduling, registration, and pre-authorization, are accurately captured for billing purposes. Technology makes administrative tasks more efficient, subsequently reducing healthcare and administrative costs (Harrington, 2019). The EHRs, therefore, play an essential role in revenue cycle management as the healthcare industry transitions to value-based care models.

Monitoring Tools The monitoring tools used in revenue cycle management are charity care and patient access insurance verification rate. Insurance verification is a process through which hospitals contact insurance companies to ascertain if the client’s healthcare benefits cover the necessary treatment interventions. This process is undertaken before the medical services are initiated (Analytix, 2019). The insurance verification rate monitors the precision and effectiveness of the verification process.

Hospitals also use the expense tracking tool for financial management purposes. The expense tracking tool is accounting software integrated into the healthcare system. This tool helps hospitals determine if the activities that need reimbursement are beneficial to the organization and the patients. Finance officers use this tool to find out if the expenses have decent returns.

Implications of the EHRs to RCM and Reporting

3 An electronic health recording system is integral to revenue cycle monitoring and reporting. The system creates a platform for accurately capturing clinical and administrative data.

This data is later on analyzed for billing purposes. Information captured by care providers on the EHRs is translated into medical claims system for accurate billing (Hoyt & Hersh, 2018). Data collected using EHRs is fundamental as healthcare reimbursements shift towards value-based care. It helps identify the services provided to patients and whether the intended care outcomes were achieved (Hoyt & Hersh, 2018). The implementation of an accurate billing process is vital in running a successful medical practice. It ensures that medical data is adequately coded and charged accordingly.

Definition of Terms Corrective Coding Initiative (CCI)-Electronic Billing X12N The CMS started the correct coding initiative to control coding methodologies and facilitate appropriate payment in part B insurance claims. The CCI eradicates improper coding, which leads to improper payments.

Revenue Cycle Process The revenue cycle process is a financial process that utilizes the medical billing software to track patient care tasks from registration to payment. Some of the critical functions involved in the revenue cycle are patient registration, insurance verification, medical transcription and coding, charge entry and transmission, and AR calling. The revenue cycle process helps connect patients' clinical and administrative data (DelVecchio & Lee, 2017).

Utilization and Resource Management Utilization and resource management in healthcare is a process in which healthcare providers conduct a case-by-case evaluation of the effectiveness, appropriateness, and medical

4 necessity of services, treatments, procedures, and facilities provided to patients. The evaluation process is conducted by purchasers of medical services (Vonderembse & Dobrzykowski, 2016).

Some of the medical services subject to evaluation include ER visits, inpatient admissions, SNF patient days, outpatient visits, inpatient days, and home health visits.

5 References Analytix (2019). What is the insurance verification process and why is it important? https://www.analytixdatamgmt.com/what-is-the-insurance-verification-process-and-whyis-it-important/ DelVecchio, A., & Lee, K. (2017). Revenue cycle management (RCM). https://searchhealthit.techtarget.com/definition/revenue-cycle-management-RCM Harrington, M. K. (2019). Health care finance and the mechanics of insurance and reimbursement. Jones & Bartlett Learning.

Hoyt, R. E., & Hersh, W. R. (Eds.). (2018). Health informatics: a practical guide. Informatics Education.

Vonderembse, M.., & Dobrzykowski, D. (2016). A healthcare solution: A patient-centered, resource management perspective. CRC Press.