There are two key players in revenue cycle stream – the HIM coding department and the patient financial services department. Working together these two departments can sustain a healthy revenue cycle for any healthcare organization. These two departments are responsible for all of the basic elements of the revenue cycle -- from registration to coding the care provided to final discharge.
Patient financial services, typically, includes the registration process, and that is where the revenue stream has its head waters. An accurate registration process establishes the basis for future follow-up with payers or the patient as a self-payer.
Using their knowledge of billing rules, patient financial services applies the appropriate billing rules, such as Local Medical Review Policies (LMRPs) or National Coverage Determinations (NCDs) to produce an accurate patient bill.
The HIM coding department uses its vast knowledge of the very latest coding rules to provide patient financial services with an accurate medical record from which to produce their patient bill.
Accurate coding is the revenue stream’s main channel that keeps a healthy revenue cycle flowing through any healthcare organization. This can be accomplished by using the best possible credentialed and experienced coders available. Not only should they be AAPC or AHIMA-certified, but they should also have a minimum of three years’ experience, and be continually working to improve their productivity and to stay on top of changes in coding rules and regulations.
The group should also contain specialty-focused coders who are knowledgeable in various medical specialties. It also helps if the coders have access to a customizable rules engine for code validation.
And finally, the team should have access to a coding platform that utilizes a proprietary software application for all coding services, providing coders with the tools needed to enhance their workflow, and provide faster service.
In order to overcome the final dam in a revenue stream – denied claims – an organization should have access to expert claims denial services. Denied claims are lost money, especially when claims never get resubmitted. Sifting through the thousands of denial reasons to identify and correct errors is time consuming and costly. Administrative staffs are often ill-equipped or lack the time to tackle this monumental task. Using an experienced team of claims denial experts will provide a cost-effective solution for revenue recovery and ensure that appropriate payment is received for services provided.
If your organization lacks any of the foregoing needed expertise to keep your revenue stream flowing in a healthy manner, you may want to consider outsourcing some or all of your coding needs to Aviacode. We offer a complete solution for all of your HIM coding needs.