HIMSSCast: The middle section of the revenue cycle can be the hardest
Improvement is all about the cash flow and getting it right the first time, says Ronnie Simpson.
Photo: Tetra/Getty Images
Ronnie Simpson, vice president of Conifer Health Solutions, has worked in the revenue cycle for 15 years. He knows well that of the three parts of the revenue cycle – front, middle and backend – it's the middle section that often bogs down claims, delaying payment.
"Accounts can be caught in a swirl," Simpson said.
The middle section of the revenue cycle includes coding, clinical documentation integrity, or CDI, and edit resolution and management.
Obviously, no provider wants accounts waiting on additional documentation to get paid. The best solution is getting documentation and charge capture right the first time, and this means before the patient is discharged, Simpson said.
For more of a breakdown of Simpson's recommendations, listen to his conversation with Susan Morse, executive editor of Healthcare Finance News.
Talking points:
- Revenue cycle workforce includes a large global population.
- CDI is important as a clinical review of the record, to ensure the provider has captured the most accurate health story of the patient.
- If the story is told incorrectly, or if it's embellished, the claim will likely be sent back for more information.
- Accelerate cash flow from scalable solutions that get documentation right the first time.
- Coding is critical to completing accounts as quickly as possible.
More about this episode:
Private payers deny 15% of claims, survey finds
UnitedHealth AI algorithm allegedly led to Medicare Advantage denials, lawsuit claims
No Surprises Act implementation coincided with in-network claims growth
Claim denials and payer audits are affecting the revenue cycle
Email the writer: SMorse@himss.org
