Revenue Cycle Checklist for Health Care Institutions

OPTIMIZE ROLES

OPTIMIZE PROCESS

OPTIMIZE TECHNOLOGY

Create a Clinical Document Integrity (CDI) team

The goal of a CDI team is to support physicians and other clinicians with complete and accurate clinical documentation, including the specificity of current conditions to allow for accurate and timely coding. Clinical Documentation Specialists should have both clinical, typically nursing, and medical coding backgrounds.

Design and implement a Denial Management Program

Focus on creating a program with efficient workflows so you can address denial-related errors as quickly as possible. Your process needs to include data gathering, root cause analysis and clinical and financial expertise to drive process improvement recommendations.

Reduce interruptions with automation

Which parts of the revenue cycle process do your clinicians and administrative staff need to actively “touch” to facilitate payment? Look for opportunities to automate these areas and reduce manual touchpoints. Specifically, consider areas like front-end access, claims management, claim follow-up, contract management and cash application and management.

Formalize your relationships with payers

Ensure your payer contracts include clearly defined escalation processes to address denial and payment issues. This includes the creation of joint operating committee structures tasked with managing payer-provider collaboration, issue resolution and mediation. Highly formal and structured contracts will help you ensure issues are handled in a consistent, timely and standard manner with minimal ambiguity.

Create a process for handling post-payment audits

Over the last few years, the claim lifecycle has become significantly more complex, with pre- and post-payment editing and auditing increasing exponentially. Now that post-payment audits are a regular fact of life as opposed to an occasional occurrence, you need a standardized process for handling them. Your priority should be to increase speed, efficiency, and accuracy.

Use AI and RPA to streamline your processes

Explore integrated technologies like robotic process automation (RPA) and artificial intelligence (AI) to expand the universe of work you can take off your staff’s day-to-day activities. Make sure you stay abreast of advancements in these technologies — as their capabilities expand, you can mature the automation behind your processes.

Optimize your electronic health record (EHR) system and supporting technology

To get the most value out of your EHR system, IT, clinical and revenue cycle operations need to work in tandem. Tuning your technology to support efficient workflows will ensure you achieve optimal outcomes.