Clinical care claims are the driving force behind any healthcare organization’s revenue cycle. When physicians use clinical documentation for building compliant claims, they increase their chance of initially submitting clean claims, and their claims consistently match medical records. Ultimately, this lowers the number of claim denials, increasing reimbursement and limiting financial loss. Furthermore, taking the above measures improves patient-care quality.
According to Cerner Health Technologies, adopting a clinically-driven revenue cycle is a thoughtful process. Physicians seeking to establish a clinically-driven revenue cycle must make sure to consider their office staff, supplying them with any resources required to efficiently do their jobs, holding them accountable when necessary, and acknowledging when they go above and beyond. Along with the above considerations, physicians must understand that adopting a clinically-driven revenue cycle is a transformation of the way a practice functions. This requires a culture that fosters a sense of empowerment and good communication amongst all member of the practice (physicians, administrators, and staff). Clinical data documents, reports, policy changes, and metrics are all key aspects to communication within a physician’s practice. Physicians should adopt for their practice a systematic communication plan and determine who needs information, what information needs to be disseminated, how to deliver that information, and who will be accountable for that communication.
Cerner also suggests that a financially successful clinically-driven revenue cycle involves adopting long-term operational metrics. Physicians should consider the benefits of adoption, like lower losses (and, as a result, ultimately lowered interest from third-party auditors), improved clean claim rates, increased revenue gained, and decreased revenue lost. Clinically-driven revenue cycles serve to facilitate advanced integration between clinical and financial information, along with coding improvements and increased billing accuracy.
Via technologically-enhanced coding and clinical documentation, adoption leads to more accurate reimbursement. By adopting efficient technologies into their practices, physicians can provide near real-time documentation when its needed. Cerner recommends that the clinical leader is the ideal person to manage real-time documentation, as they will be most aware of the volume of work produced by office staff. Near real-time transaction management increases efficiency in billing to obtaining patient records to automating patient status. This improves clinical documentation, allows for earlier case-management reviews, and provides accurate revenue reports. Physicians would also benefit from having a physician champion at their practice, someone who helps the practice follow a single process from orders to scheduling, helps retain or improve patient satisfaction levels, and helps to improve resource efficiencies.