Topic Hub

Revenue Cycle Management: Resources and Strategies

A resource hub from Relias to help healthcare organizations optimize their revenue cycle and coding processes to maximize organizational stability, financial health, and patient satisfaction.

Accuracy and Integrity

A healthcare organization’s revenue cycle spans the entire patient processing timeline, from registration to when the patient’s account is closed. Medical coding and billing are key parts of the cycle and critical for ensuring that the organization has the right data to accurately document patients’ care, avoid claim denials, and obtain timely and complete reimbursement.

The integrity of these financial functions is intrinsic to your organization’s financial health. Without it, business operations can suffer. Levels of patient care and satisfaction could fall, and the organization’s ability to offer patient services could be jeopardized. Taking steps to bolster the strength of your financial team not only improves care quality and satisfaction — it could also help avoid audits, fines, and penalties.

Putting the Pieces Together: People, Processes, and Payments

Navigate this page for resources on all aspects of the revenue cycle and coding — from recruiting and retention to ensuring clinical documentation integrity and avoiding pitfalls and problems.

Building and Sustaining a Highly Skilled and Engaged Coding Team

Recruiting and retention: In a challenging climate where healthcare organizations must compete to hire and retain the best staff, coding and billing specialists are no exception. Organizations may need to offer more than in the past to attract and retain the talent they need to ensure accurate coding and billing that makes timely, full reimbursement possible.

Change Healthcare reported in 2020 that over 34,000 openings for medical records and health information specialists are projected each year to 2030. It was also reported that staffing challenges contribute to the following problems:

  • Difficulty hiring highly qualified coders with complex knowledge and skills in an environment of frequent regulatory changes
  • Lack of experienced coders who can help prevent claim denials
  • Lack of expertise to support appeals
  • A need for more staff to manage claim backlogs and a growing number of denials

Understand what your coding staff looks for in an employer: So, what can your organization do to attract the best coders? Here are the four tips covered in our e-book on recruiting and retaining highly skilled coders:

  1. Provide coders with continuous education.
  2. Recruit new coding staff by offering something different than your competitors.
  3. Retain your current coding staff by increasing engagement.
  4. Show coders they’re highly valued at your organization.

Interested in learning how to accomplish each of these four strategies? Download the e-book below.

Educate your coding team early and often: Providing education for your team must be an ongoing effort. New staff members need intensive onboarding to prepare for taking on their responsibilities, but existing staff members also need regular training on compliance topics and coding changes that occur throughout the year. Through the Relias Platform, you can provide training updates for your team automatically and eliminate the risk of outdated training.

With Relias, your team will have access to over 700 self-paced lessons on an extensive range of topics covering all phases of the revenue cycle. Our courses are continuously updated with coding and regulatory changes and are accredited by AAPC, AHIMA, ANCC, and ACCME.


How Clinical Documentation Integrity Protects Your Bottom Line

An investment in quality continuing education for your coders pays off in numerous ways. Not only does it offer an attractive recruitment incentive and elevate your hiring potential — it also builds the skills of your existing team.

Employees who gain the necessary skills expand their qualifications and perform better on the job. Better performance translates to job satisfaction, and most of all, boosts your bottom line in terms of time savings, efficiency, and accuracy. Achieve savings and maximize revenue through the following:

  • A better bottom line through clinical documentation integrity: Complete and accurate coding has a profound impact on an organization’s bottom line. To achieve it, a robust clinical documentation integrity (CDI) program is a must.
  • Risk mitigation: Inaccurate or incomplete coding doesn’t just threaten appropriate reimbursements, it also jeopardizes patient experience, satisfaction, and quality of care and could even harm a provider’s reputation. In extreme scenarios, unintended fraud could occur.
  • Driving efficiency and cash flow: The benefits of a CDI program extend beyond initial claim payment to include preventing audits and fines that can delay or reduce reimbursements. CDI specialists need to be well versed in regulations and payer requirements while maintaining up-to-date education on coding and documentation within their speciality areas.

Ensuring Correct Reimbursements to Complete the Cycle

All of your healthcare organization’s efforts to strengthen its revenue cycle should lead to the primary goal of receiving accurate and complete payments. Full reimbursement ensures that you can continue to provide care and services to your communities.

In addition to bringing in full payment for claims filed, eliminating rework that could cut into your revenue is also an important part of the revenue equation. Make sure you are benchmarking the following when applicable:

  • Appropriate reimbursements: The CMS prospective payment system links appropriate reimbursement to the documentation in the medical record. Under this system, accurate and timely documentation directly determines how well a hospital performs financially.
  • Value-based reimbursements: More private payers are adopting value-based care models that tie payments to quality of care and reward providers for efficiency and effectiveness. Eventually, the Centers for Medicare and Medicaid Services (CMS) aims to tie all Medicare payments to value-based care models.

Additional Resources

How Relias Can Help

By enhancing your entire care team’s competence in revenue cycle and coding topics through ongoing education, you can secure the safest care environment, help ensure optimal patient outcomes, and ultimately strengthen the financial position of your organization. In a highly complex and ever-changing regulatory environment, clinical documentation integrity expertise is crucial for the long-term financial health and stability of healthcare organizations.

Ready to learn more about how Relias can help you educate your staff in revenue cycle management?

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