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Improving the efficiency of the revenue cycle is still being refined through technological advancements and by restructuring the documentation and billing procedures. Before the advent of integrated data collection technologies and real-time communication, the old way of generating claims and receiving payment was a much longer process than it is today. Updating the revenue cycle process with several key features improves the quality of patient care and satisfaction and the overall payment process. Here we describe a couple of new key features that help optimize the revenue cycle.
The old way of billing and coding
The old way of generating claims relied heavily on the efforts of physicians that extended beyond their clinical duties. These involved data entry tasks, reviewing of charts and writing up the required documentation of each patient encounter; these were then sent to back office billing and coding personnel who would generate the code-based claims. Often a time-consuming bottleneck to the payment process, this phase of the revenue cycle required back and forth clarifications between physicians and billing staff before actual claims could be sent off to the payer.
As mentioned in several of our previous blogs, every day that claims sit in a payer system waiting to be paid represents a loss of revenue to the healthcare provider. This loss of revenue can prove to be costly to the practice or hospital. The major problem with the old billing procedure is the time spent processing claims and the toll it takes on physician workload and on the quality of patient care and satisfaction; not to mention the added possibility of claims being later rejected. Appealing a rejection is possible, but this results in time and effort spent on arguing for a claim before due payment.
Incorporating newer elements into the revenue cycle
The current method of generating claims integrates several features that focus on speeding up the revenue cycle. The goal is to increase the efficiency of processing accurate claims through clean, clear documentation and coding so that payment is faster and the probability of claim denials is reduced. Two main strategies exist to overcome revenue cycle woes: 1) using certified, trained medical scribes to ensure accuracy in patient documentation and 2) using real-time healthcare to better coordinate between the different parties involved in the revenue cycle. Medical scribes are trained to record the details of patient examinations clearly and accurately and are well-versed in EHR data entry and ICD-10 codes needed for a proper medical claim. Introducing real-time communication between medical scribes and back office billing personnel to discuss correct coding immediately at the point of care, achieves the accuracy in both clinical and coding documentation needed for successful payment of a claim in much less time than before. Physicians need only to quality check and approve the documentation made by the scribe when it is done — a task made easier since the medical scribe is present during the examination and can receive direct feedback from the physician. This three-way interaction ensures that patient claims are as accurate and clear as possible, reducing the likelihood of errors or ambiguities that can lead to a denial of a claim.