Question

Grace Greene, RHIA, has been offered a leadership position at Greater Good Hospital to assist in improving the hospital’s revenues. The hospital recognized that her knowledge and experience in coding and clinical documentation would be valuable in this effort, but these are not the only skills that will be needed to fine-tune the hospital’s revenue cycle. Recognizing that many components of the revenue cycle and that many hospital departments have a role to play, what are some of the processes that Grace and her team should examine in assessing where the hospital currently stands and in looking for possible areas of improvement?

Answer 1

Grace and her team should examine processes such as patient scheduling, medical coding and documentation, charge capture, claims submission, denial management, patient billing experience, and benchmarking against industry standards to improve the hospital’s revenue.

Step-by-step explanation:

Grace Greene, RHIA, has a significant task ahead as she looks to enhance Greater Good Hospital’s revenues. To assess the current standing and identify improvement areas, Grace and her team should analyze several processes that integrate throughout the hospital’s revenue cycle.

Among these, they should closely review patient scheduling and registration for accuracy and efficiency, ensure rigorous medical coding and clinical documentation which directly impact billing and reimbursements, and scrutinize the charge capture mechanisms to avoid lost revenue from missing or undercharged services.

Additionally, a precise process for claims submission and a robust system for managing denials and underpayments are critical. Grace should also consider the patient experience with the billing process, as this can affect patient satisfaction and subsequent revenue through repeat visits and referrals. Lastly, benchmarking performance against industry standards and other institutions can reveal areas for potential revenue enhancement.