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Maximizing Relationships within the Revenue Cycle
Chris Johnson CHFP Senior Revenue Cycle Consultant Trubridge, LLC
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Agenda
• History/Background
• Roles and Responsibilities
• A walk through the Revenue Cycle
• Revenue Cycle Steering Committee
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Look familiar?
HIM Director PFS Director
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Is this how you see your PFS Director?
HIM Director PFS Director
Is this how your PFS Director sees you?
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Let’s end the feud
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History/Background
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History/Background of HIM • Medical Record’s roots stemmed from early
Astrologers in the 14th century • Hospitals began keeping Medical Records in the late
1700’s • 3 categories of early medical records:
– Rudimentary (Europe): • Lists the names of clients and their payments for
treatment
– Narratives of Cure (Greece): • Recorded advice to patients about diet, recipes, and
lessons for surgeons
– Early Modern (England): • Name, date, complaint, history, diagnosis,
remedy/therapy and payment
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History/Background of PFS
• The Industrial Age resulted in mills and factories seeing an increase in work related injuries
• Doctors charged what they felt patients could afford on a case-by-case basis
• No standard payment system
• In the 1920s, individual hospitals began offering services on a pre-paid plan (i.e. Insurance)
• Great Depression caused hospital administrators to face a choice of federal funding for the poor
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Now let’s talk about roles
No…not that kind of rolls
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Roles and Responsibilities
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Roles:
• Health Information Management (HIM) – the practice of acquiring, analyzing, and protecting
medical information vital to providing quality patient care. It is a combination of business, science, and information technology.
• Patient Financial Services (PFS) – administrative functions that contribute to the capture,
management, and collection of patient services revenue
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HIM
• Paper Chart
• Electronic Record
• Collecting Documentation
• Coding
• Queries
• ROI
Responsibilities:
PFS
• Patient Access
• Revenue Capture
• Claims Submission
• Claims Follow-Up
• Rejections/Denials
• Reimbursement
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Always a Balancing Actct
PFS
Dollars
Collect monies due, timely
Data
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Always start with the Why?
Data vs.
• Disease Management
• Record of Documentation
• Claims Submission
Dollars
• Provides Capital for
• Equipment
• Facilities
• PAYROLL
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• Both employ the same basic skills
– Eye for detail
– Knowledge of medical terminology
– Knowledge of HIPAA
– Proper completion of medical forms
• The best coders have knowledge in billing
• The best billers have knowledge in coding
• Comparable salaries and a high expected employment growth
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A walk through the Revenue Cycle
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The Revenue Cycle Insanity
DENIAL &
APPEAL
MANAGEMENT SCHEDULING
PRE-REG &
PRE-CERT
INSURANCE
VERIFICATION
FINANCIAL
COUNSELING
REGISTRATION
CHARGE
CAPTURE
& ENTRY
MEDICAL
MANAGEMENT CLAIMS
SUBMISSION
THIRD PARTY
FOLLOW-UP
PAYMENT
POSTING
CONTRACT
NEGOTIATION /
ADMIN.
REJECTION
PROCESSING
MEDICAL
RECORDS &
CODING
PATIENT
Revenue
Information
Systems
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The Revenue Cycle Simplified
Patient Access
Data Processing
HIM Insurance
Collections
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Patient Access
Scheduling Pre-Reg Registration
Data Processing
Charge Capture
Receipting Closing
A/R Days
HIM Chart Prep Deficiencies Coding
Insurance Billing Edits Claims
Submission Claims
Follow-Up
Collections Financial Counselors
Patient Statements
Bad Debt Write-Offs
Step-by-Step
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The Revenue Cycle Simplified
Revenue
Reg. Scheduling/ Pre-Reg
Charge Capture
Coding Accuracy
Billing Edits
Rejection/ Denials
Appeals/ Underpays
Data Analysis
Clinical Documentation
1. Do We Have a Leaky Pipe? 2. Where are the Leaks? 3. Collaborate to Plug the Leaks.
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Revenue Cycle Steering Committee
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– To ensure effective communication, involvement of key senior management personnel is critical.
– Establish mechanisms to facilitate formal and informal communication with key hospital members.
– This committee should continue indefinitely, while evolving and growing to meet the facility’s needs.
Revenue Cycle Steering Committee
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Revenue Cycle Steering Committee
• Steps to begin:
– Meeting charter
• Compliance and Collections
• Participants and their roles
• Recurring location, date, time
– Report Card
– Action Plan
– Subcommittees
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www.trubridge.com @trubridgesvc
Keyword TruBridge
facebook.com/trubridgeservices
Chris Johnson CHFP Senior Revenue Cycle Consultant Trubridge, LLC