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Integrating the Health System Revenue Cycle

Rene Letourneau, for HealthLeaders Media, March 24, 2014

As healthcare CFOs work to protect the fiscal strength of their organizations, they are increasingly aware of the need to engage clinicians from across the continuum of care in the revenue cycle process.

This article appears in the March 2014 issue of HealthLeaders magazine.

Although there has long been a divide between the finance and clinical departments in many hospitals, those days may be coming to an end. As healthcare CFOs work to protect the fiscal strength of their organizations, they are increasingly aware of the need to engage clinicians from across the continuum of care in the revenue cycle process.

Collecting better documentation

In 2012, Southwest General Health Center, a 358-bed institution in Middleburg Heights, Ohio, completed several clinical integration initiatives for a total revenue improvement of $2.8 million. Southwest General reported patient revenues of $291 million that same year.

Mary Ann Freas, the system's vice president and chief financial officer, says the initiatives are important because "so much of the revenue cycle is in the hands of our frontline staff and providers."

Freas says the clinical team often does not gather all the information needed for billing because they are busy managing many other tasks and may not realize the importance of complete and accurate charge capture.

"We want to make sure they know we understand what they are going through and that their priorities are around taking care of patients, but at the same time, we need to collect dollars for the services we provide," Freas says. "One way to do that is to connect the dots and make sure they understand there is a connection between the documentation and our payment."

Among the initiatives Southwest General started in 2012 is the capture of IV administration documentation for observation and emergency department patients. Although many patients in its ED get an IV for drugs or hydration, Southwest General was not always able to bill for this service because nurses were not collecting enough information. "If you don't have the start and stop time, for us particularly the stop time, you can't get paid for the IV," says Jill Barber, Southwest General's director of managed care operations.

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2 comments on "Integrating the Health System Revenue Cycle"


Lisa Sams MSN, RNC (3/24/2014 at 4:53 PM)
Managing the complexity of revenue today is clearly a moving target and demands the attention of clinical teams as well as the C-Suite. But I am greatly disturbed to read yet another article that looks at the care of patients (people in your community who trust you to provide safe quality care) as numbers and dollars only. What about the new mantra of "patient engagement" and HCAHPS results where the $$ will be lost because the nurse or the doctor does not listen to me. As a long time clinicians it is painful to recognize that the same people focused on the numbers are not aware of what it takes to prevent yet another infection with the urinary catheter or a medication error. Perhaps it is time for the C Suite and the financial folks to follow the management adage..."leadership by walking around". Spend time in the ED watching the clinicians managing people like old Mr Jones with CHF and type II diabetes...who lives alone, has ARMD and cannot read his med bottles easily. It is time folks who do not provide direct care to walk in the shoes of those who are at the bedside. It may help you understand how to bridge the gap in data gathering by some other means than adding yet another layer to the EHR screen. Please start thinking out of the box..

Robert Sigmond (3/24/2014 at 10:52 AM)
The most effective way to integrate the Health System Revenue Cycle is to integrate the entire revenue, expense and caring cycles, all three. This should be under a single manager/coordinator of the entire process, preferably some one who knows how to manage money but also knows how to influence and manage the people who are managing the care. For detailed information of one way to integrate the entire process, see my paper in INQUIRY entitled ""Doing Away with Uncompensated Care". That paper outlines a six part management plan to maximize collections and quality of care and quality of recording and processing data on both care and on billing. The person in charge should report to the COO or CEO, not to the CFO. The INQUIRY paper can be found on my web site: "sigmondpapers.org" or ,com. I would love to hear from anyone interested in pursuing this idea: 215-561-5730. Regards, Bob