Revenue Cycle Management Documentation and Process Measurement
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The document discusses a healthcare revenue cycle process resource center that provides a customizable framework to optimize revenue cycle management processes through visual illustrations of workflows, responsibilities, metrics and other resources to improve collaboration, standardization, and process optimization across organizational departments and stakeholders. It highlights how the process resource center enables executive-level systemic visibility and integrity as well as operations-level proactive management of revenue cycle performance.
Revenue Cycle Management Documentation and Process Measurement
- 1. Healthcare Revenue Cycle Process Resource Center --------------- Value is Measurable, but It’s Hard to Measure What You Can’t See
- 4. Reduced Throughput Increased Cost per Unit Does Not Meet Margin per Unit Target Process Configuration Optimized Meets Margin per Unit Target Process Optimization Analytics and Management Control Charts
- 5. Process Resource Centers • Resource Types: o Policies o Workflows o Procedures o Applications o Analytics & Metrics o Video o Other web sites • Reside Internally or In the Cloud • Web Frameworks That Optimize Visualization and Execution of Corporate Endorsed Processes, Activities and Associated Resources
- 6. Customizable Revenue Cycle Management Process Resource Center • Patient Engagement o 1.0 Pre-Arrival o 2.0 Day of Visit • Billing o 3.0 Visit/Charge Capture o 4.0 Claim Production • Follow-up o 5.0 Financial Services o 6.0 Insurance Accounts Receivable Management o 7.0 Patient Accounts Receivable Management o 8.0 Credit Balance
- 7. Workflow with Information Button, Document Links, and Shared Responsibilities
- 9. Defines and Visually Illustrates End-to-End Roles, Responsibilities, Expectations, and Dependencies of All Departments, Stakeholders, and Business Partners Serves to Penetrate Departmental Silos, Tool Conflicts, and Tribal Knowledge Improves Communications and Collaboration Shared Responsibility Mapping Combines SIPOC & RACI
- 10. Shared Responsibility Maps Illustrate Multistep Activity/Process Dependencies Activity/Process Step 3 Activity/Process End Activity/Process Step 1 Activity/Process Step 2 Step 1 Outputs & Customer Becomes Step 2 Supplier and Inputs Step 2 Outputs & Customer Becomes Step 3 Supplier and Inputs Activity/Process Start Variation in Earlier Phases Influences Performance and Deliverables in Latter Phases
- 11. Revenue Cycle Management Across the Organization – Shared Responsibility Board of Trustees Chief Executive Officer Chief Medical Officer ----------- Charge Capture Administration Chief Financial Officer ----------- Financial Services & Billing Chief Operating Officer ----------- Charge Capture, Pre-Arrival, & Day of Visit Departments • Human Resources • Development Departments: • Adult Primary Care • Pediatrics • OB/GYN • Urgent Care • Eye Clinic • Specialists • Nutrition ----------- 3.1 – 3.3 Charge Capture Practice Management ----------- Pre-Arrival & Day of Visit Departments: • Medical Records • Switchboard Registration ----------- 1.3 Registration Intake ----------- 1.4 Intake Clinical Secretaries/ Referrals Nursing ----------- Charge Capture Quality/ Lean Dental ----------- Charge Capture Lab ----------- 3.3 Charge Capture Departments: • Compliance • Quality Incentives • Mehi Program Management Social Services ----------- Charge Capture Facilities Department: • Billing ----------- 3.4 – 3.5 Coding/Charge Entry And 4.1 – 4.5 Claim Producton Finance (Financial Services) Departments: • IT-CIO • Payroll/ Benefits • Managed Care Accounting/ Purchasing Departments: • Environment al Services • Security • Maintenance Departments: • Behavioral Health • Mental Health • CHWs • Interpreters • HIV/STD • HRC ----------- 3.1 – 3.3 Charge Capture 3.0 CHARGE CAPTURE/ Coding/Charge Entry 5.0 FINANCIAL SERVICES 6.0 INSURANCE AR MANAGEMENT 7.0 PATIENT AR MANAGEMENT 8.0 CREDIT BALANCE 2.0 DAY OF VISIT 1.0 PRE-ARRIVAL 4.0 CLAIM PRODUCTION PATIENT ENGAGEMENT FOLLOW-UPBILLING
- 12. Shared Responsibilities and Process Measures
- 13. Billing Company Client Lifecycle Management 3.0 CHARGE CAPTURE/ Coding/Charge Entry 5.0 FINANCIAL SERVICES 6.0 INSURANCE AR MANAGEMENT 7.0 PATIENT AR MANAGEMENT 8.0 CREDIT BALANCE 2.0 DAY OF VISIT 1.0 PRE-ARRIVAL 4.0 CLAIM PRODUCTION PATIENT ENGAGEMENT FOLLOW-UPBILLING Billing Company (BC) Revenue Cycle Management Client Lifecycle Management Client BC 3.0 Client Onboarding Applications, Their PRC, Engagement Procedures 2.0 Client Onboarding 1.0 Client Onboarding Client Lifecycle Management 1.0 Ongoing Daily Activities 2.0 Client Access to Their PRC, Analytics and Reporting 3.0 Ongoing Account Reviews 1.0 Client Offboarding 2.0 Client Offboarding 3.0 Client Offboarding Client BC
- 14. Billing Company Employee Lifecycle Management 3.0 CHARGE CAPTURE/ Coding/Charge Entry 5.0 FINANCIAL SERVICES 6.0 INSURANCE AR MANAGEMENT 7.0 PATIENT AR MANAGEMENT 8.0 CREDIT BALANCE 2.0 DAY OF VISIT Consulting ?? 1.0 PRE-ARRIVAL Consulting ?? 4.0 CLAIM PRODUCTION PATIENT ENGAGEMENT FOLLOW-UPBILLING Billing Company (BC) (Draft) Revenue Cycle Management Employee Lifecycle Management Client BC 3.0 Onboarding Employee Handbook Training Team Assignment 2.0 Testing 1.0 Interviews Employee Lifecycle Management 1.0 Ongoing Daily Activities 2.0 Client/Team Management 3.0 Client/Team Management 1.0 Employee Offboarding 2.0 Credential Revocation 3.0 Outgoing Discussion Client BC
- 16. RCM Systemic Visualization at the Executive Level • Visual Systemic Transparency o Ability to “look through” KPIs to the processes, activities, and their related resources, ownership, and measures o Ensure process designs and execution are aligned with corporate strategy o Improved standardization and productivity • Visual Systemic Integrity o Validate end-to-end data consistency o See and analyze process handoffs for performance deficiencies, bottlenecks, and disconnects o Get teams on the same page quickly o End-to-end shared responsibility mapping illustrates who has responsibility for what, when, and to whom • Improve Organizational Retention of Best Practices Despite Turnover • Immediately Accessible, Viewable, and Presentable from Any Device
- 17. Operations Level Proactive Management • Procedural Content is Visually and Operationally Consumable o Users can quickly see, understand, and execute the task at hand • Control Charts Available to Enable Proactive Adjustment of Workflows to Reduce Variation and Increase Predictable High-Quality Outcomes • Improved Comprehension and Accessibility Reduces Learning Curves and Procedural Errors • Decisions and Actions are More Easily Defendable o Policies, standards, best practices, and work instructions incorporated, linked, and available where it makes sense in workflow execution • Accountability is Transparent o Shared responsibility mapping illustrates who has responsibility for what, when, and to whom • Immediately Accessible, Viewable, and Presentable from Any Device
- 18. Information and Contact Henry Draughon Process Delivery Systems (972) 980-9041 hdraughon@processdeliverysystems.com