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To Improve Hospital Collections, Move Revenue Cycle Up Front

Rene Letourneau, for HealthLeaders Media, April 15, 2013

Richmond believes another major advantage to creating a front-end driven revenue cycle is it takes the administrative work out of the clinical setting and improves the overall experience for both patients and physicians.

"High-performing revenue cycle departments have shifted from back-end to front-end processes. It allows the clinical sites to focus on patients while administrative processes can occur in the background… It is about separating the administrative process from the clinical encounter."

"It lets the patient focus on their care. In essence, they arrive, have a quick check-in, and the physician can see them on time. You have a happier patient and a happier physician. Otherwise, it just winds up not being the ultimate experience for either party," Richmond adds.

Before the pre-service center went live, Richmond spent a considerable amount of time educating people within his organization to prepare them for the new business model and to try to overcome any cynicism.

"I wanted everyone to understand how it could impact the patient experience and the physician experience. I did presentations among many physician practices here, as well as a lot of education and discussion forums. That doesn't mean people weren't skeptical, but the proof is in the pudding," he says.

Richmond will share his story during his presentation, "How a Pre-Service Center at MetroHealth System Improved Satisfaction, Efficiency, and Revenue" at HFMA's ANI conference in Orlando on June 18.

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3 comments on "To Improve Hospital Collections, Move Revenue Cycle Up Front"


stefani daniels (5/27/2013 at 12:43 PM)
The concept of front end revenue cycle activities for elective or outpatient services should also be applied to the hospital's ED. Attention to Medical necessity determinations and compliance issues is just as important. Too often patients are admitted as inpatients only to find out after the fact that they do not qualify for inpatient services. Then its all about catch-up and back end fixes. And then there are the physicians who insist upon an inpatient admission and the hospital's compliance with issuing ABN or HINN notices. And of course, the issue of inpatient vs outpatient, which if not clearly discussed with the patient from the outset, leads to patient dissatisfaction and sticker shock when they receive an unexpected bil.

Tom Kincheloe (4/19/2013 at 3:34 PM)
I own a private outpatient rehab facility that provides both OT and PT as well as lymphedema therapy. This concept of front-end servicing is not new to us; my staff have been pre-screening insurance coverage for payment type, co-pays and to ensure that each plan allows for therapy coverage. We've seen cases where a particular insurance plan would cover one therapy but not the other. We've also used this concept to screen out problem insurance payers so that we can tell patients that we do not cover or are not in network with a particular plan. This method has saved us tens of thousands of dollars in loss revenues. It's also saved many of our patients from unexpected out-of-pocket costs. It's an excellent concept and one I endorse wholeheartedly.

Joan McCarthy (4/16/2013 at 11:54 AM)
This seems like an easy process to develop but it takes good systems and knowledgable people to actually complete. Very good article. What appears so intuitive at first glance has not been the practice across the healthcare settings.