Suzanne Lestina, director of revenue cycle at the Healthcare Financial Management Association, discusses four trends in revenue cycle management.
1. Integration with overall goals of the hospital. In the past five to 10 years the goals of revenue cycle management have become more closely intertwined with the larger goals of the hospital. As a result, the vice president for revenue cycle has been given expanded responsibilities, such as oversight of managed care contracting. A close working relationship with managed care helps in many ways, including making it possible to provide price estimates to patients at the point of service.
2. More focus on self-pay receivables. Out-of-pocket payments are growing in two ways. Hospitals are seeing a long-term increase in out-pocket payments by insured patients and a short-term increase in the number of uninsured patients. Effective point-of-service-payments have to overcome many barriers, such as lack of data on what the patient owes and reluctance of staff to begin the conversation.
3. Preparing for ICD-10-CM system. The ICD-10-CM diagnosis coding system, which will be adopted on Oct. 1, 2013, will be substantially more robust than the current ICD-9 system. Using optional sub-classifications, ICD-10 codes can be expanded to over 16,000 codes. Physicians and clinical coders will need extensive consultation and review, and hospitals will have to meet HIPAA 5010 requirements for electronic healthcare transactions, which will be implemented in 2012.
4. Upgrading information technology. While information technology is frequently linked to clinical data, it is just as essential for efficient oversight of the revenue cycle. Hospitals should be undertaking a thorough review of information technology to make sure it meets standards like "meaningful use," which are required to receive federal IT payments under the stimulus bill.
Learn more about the HFMA.
1. Integration with overall goals of the hospital. In the past five to 10 years the goals of revenue cycle management have become more closely intertwined with the larger goals of the hospital. As a result, the vice president for revenue cycle has been given expanded responsibilities, such as oversight of managed care contracting. A close working relationship with managed care helps in many ways, including making it possible to provide price estimates to patients at the point of service.
2. More focus on self-pay receivables. Out-of-pocket payments are growing in two ways. Hospitals are seeing a long-term increase in out-pocket payments by insured patients and a short-term increase in the number of uninsured patients. Effective point-of-service-payments have to overcome many barriers, such as lack of data on what the patient owes and reluctance of staff to begin the conversation.
3. Preparing for ICD-10-CM system. The ICD-10-CM diagnosis coding system, which will be adopted on Oct. 1, 2013, will be substantially more robust than the current ICD-9 system. Using optional sub-classifications, ICD-10 codes can be expanded to over 16,000 codes. Physicians and clinical coders will need extensive consultation and review, and hospitals will have to meet HIPAA 5010 requirements for electronic healthcare transactions, which will be implemented in 2012.
4. Upgrading information technology. While information technology is frequently linked to clinical data, it is just as essential for efficient oversight of the revenue cycle. Hospitals should be undertaking a thorough review of information technology to make sure it meets standards like "meaningful use," which are required to receive federal IT payments under the stimulus bill.
Learn more about the HFMA.