HIM Takes a Front Seat in Revenue Cycle

1. HIM Takes a Front Seat in Revenue Cycle June 21, 2012 Kathy Whitmie

2. Intro Statement: No single process is more critical to effective revenue capture than health information management (HIM). TRUE OR FALSE Because the revenue cycle both begins and ends with medical records, a well planned reengineering of HIM processes yields measurable overall improvements in revenue cycle performance. TRUE OR FALSE Nonetheless, many organizations continue to undermine their entire revenue cycle by underrating the importance of HIM processes. TRUE OR FALSE HIM/Medical Records: Is the Underrated and Seldom-stated Driver of Revenue Cycle Success TRUE OR FALSE

3. Background Across the country, many hospitals have sought to make positive improvements in their revenue cycle process flows, particularly in the areas of patient financial services (PFS) and patient access. These improvements are generally the result of: • a detailed evaluation of existing practices, • a thorough understanding of needed changes, and • the proper implementation of performance improvement measures.

4. Background Despite these well intentioned efforts, however, many facilities often struggle to incorporate HIM enhancements, thus failing to benefit from HIM’s significant contribution to the revenue cycle. • Too often, the only effort made to address HIM is a heightened focus on the management of the Did Not Final Bill (DNFB) report. TRUE OR FALSE

5. History Historically, the industry has generally been slow to include the HIM department in its definition of the revenue cycle. Organizations are now realizing that the revenue cycle is not a standalone financial process composed of a front end and back end, but that HIM (the territory that stands between the front end and back end) can become a major driver. TRUE OR FALSE

6. How? Reengineer the Revenue Cycle process beginning with a strategy that focuses on the long-term resolution of problems.

7. The Revenue Cycle

8. First Step of the Strategy Develop appropriate policies and procedures to support continued monitoring and quality improvement address known issues and measure progress, allow for open communication and an appropriate balance of the people, processes, and technology involved in successful HIM reengineering.

9. Strategy Asuccessful strategy clearly communicates well defined goals to all staff involved and states how every area of the organization will play a role in the overall plan. It is important that all involved are committed to the new strategy and become true stakeholders from the beginning.

10. Process A thorough review of all current processes is necessary. By using flow charts to track all current processes, issues such as bottlenecks and redundant tasks can be identified, and solutions can be studied. In determining recommendations, it is important to involve a cross-section of all stakeholders by assembling an interdisciplinary team or teams.

11. Assessment An assessment of current technology must also take place. This should include: the evaluation of current software releases and a review of exactly how existing systems are being used maintenance and update procedures should be assessed, with appropriate recommendations being made to resolve any issues identified in the process.

12. Team Development During the initial stages of the reengineering process, employees should continually be involved as teams to define the process and to help resolve issues and implement changes. Once the assessment and planning phases are complete, employees must remain involved not only through their own roles in the newly engineered process, but also by understanding the overall strategy and how their work fits into the big picture.

13. Stakeholder Communications Some ways of keeping communications open between different stakeholders include: Regular meetings between managers of HIM, revenue cycle, and patient access. Updates and status reports must be passed on to all staff, including physicians. Pairing employees from different departments. Coders and billers can be paired by account type, for example, to encourage interdepartmental communication and cooperation. An interdisciplinary team should also be established to identify, address, and resolve long-term issues and to deal with new problems as they arise.

14. Monitor Progress Primary to the success of any HIM initiative, monitoring of progress must take place beginning with the initial stages. Realistic goals should be established and checkpoints (milestones) defined to keep the reengineering process moving and on schedule. When problems arise, clearly defined plans targeting these areas should be created to appropriately revise processes.

15. Benchmarking Benchmarking and monitoring must continue indefinitely to assure smooth operations. Over the long run, determining a baseline and continually benchmarking HIM metrics, positions an organization as a top performer, improves both external and internal reporting, and ultimately contribute to a healthier revenue cycle.

16. Benchmarks for HIM Some appropriate benchmarks include: An HIM filing backlog of less than 2 days An error rate of less than 4 % for the assignment of duplicate medical record numbers Completion of coding in less than 3 days after patient discharge (may vary for inpatient and outpatient facilities) Total routine outpatients with missing diagnosis at 5 % or less

17. Results With realistic shared goals in place and continuous monitoring of established benchmarks, reengineered HIM processes can produce a number of quantitative and qualitative benefitsthat ultimately contribute to an organization’s bottom line and bolster competitive advantage.

18. QUANTATIVE BENEFITS Quantitative benefits include: Improving and accelerating up-front cash collections by 50 percent or more, Reducing the number of days claims remain in accounts receivable. In addition, newly gained efficiency can: Increase the number of “clean” claims, Reducing denials from 10–50 percent, Decrease bad debt by 5–25 percent. Improve resource utilization by 25–30 percent.

19. QUALITATIVE BENEFITS In terms of qualitative results, a properly executed HIM reengineering can: improve overall communication and help define and align staff members’ roles and responsibilities. Well-defined responsibilities and the careful implementation of best practices will bring about heightened accountability and enhanced performance. As a result of clearly defined roles and responsibilities, more efficient operations, and a sense of involvement, staff and physicians often exhibit improved morale.

20. SUMMARY OF BENEFITS Revenue Cycle / HIM reengineering will contribute to improved operational infrastructure and efficiency. In addition, a carefully executed integration of HIM practices in the overall revenue cycle helps align information systems, which can benefit a facility for years to come. Ultimately, all of these benefits add up to: a more effective healthcare facility and improved patient satisfaction, improved competitive advantage over the long run.

21. CONCLUSION As our recognition that HIM is a major driver in the revenue cycle process increases, it will become more important for the HIM department’s territory to expand beyond its traditional focus on assembly, analysis, coding, and chart tracking.

22. CONCLUSION Technology developments, including: the presidential mandate to move to the electronic medical record (EMR), and the drive toward computerized physician order entry (CPOE) have already impacted health care operations nationwide. To ensure continued success, healthcare facilities need to eliminate the climate of managing to survive and build a climate of managing to thrive, by recognizing HIM’s importance in the revenue cycle and capitalizing on it Reference: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok3_005690.hcsp?dDocName=bok3_005690