Revenue Cycle Management Best Practices

Each year, healthcare providers deliver more than $2 trillion in goods and services. Because of the unique healthcare payment system in the United States, few of these dollars change hands directly between providers and patients Instead, there is a complex reimbursement system, mostly dirven by third-party payment transaction between government programs and insurance companies on the one hand, and healthcare providers on the other. This system is made even more complex by the increasing necessity to collect a growing percentage of fees diretly from patients. This unique work tells the complete story of healthcare revenue cycle management. Designed to improve the efficiency of managers, the book is organized by functional area to reflect the organization of most revenue cycles. In addition to first party interviews that define best practices and provide solutions to predictable but complex challenges, the author includes a wealth of relevant literature citations. He further augments the text with a glossary, information tables, flowcharts, organizational charts, sample policies, and sample position descriptions.

This essential guide dives deep into the intricacies of Medical Revenue Cycle Management (MRCM), offering healthcare professionals, administrators, and students a clear roadmap to mastering the financial backbone of healthcare services. In a landscape where financial health is as critical as patient health, this book stands out by providing a meticulously researched, expertly written exploration of every phase of the revenue cycle—from patient registration to the final payment of balances. Without relying on images or illustrations, we navigate through complex regulations, coding challenges, and billing practices with clarity and precision, making this complex subject accessible and actionable. Our unique approach combines theoretical frameworks with practical, real-world applications, setting this book apart as a must-buy. We delve into innovative strategies for optimizing revenue, reducing denials, and enhancing patient satisfaction, all while maintaining compliance with evolving healthcare laws and regulations. By focusing on efficiency and effectiveness, we equip readers with the tools and insights needed to transform their revenue cycle processes. Whether you're looking to refine your current practices or build a foundation of knowledge from the ground up, this guide offers invaluable insights into achieving financial stability and success in the ever-changing world of healthcare.

Business improvement best practices and a proven methodology for improving corporate performance management, illustrated through a high performing program including numerous team case studies Corporate performance management consists of a set of processes that help organizations optimize their business performance. It provides a framework for organizing, automating and analyzing business methodologies, metrics, processes and systems that drive business performance. Corporate Performance Management Best Practices will help your organization benchmark itself against the best. Written by the winner of three globally accepted performance management awards Focuses on a single case study chronicling a health care system's corporate performance management journey Explores how the use of corporate performance management methods has created significant and broad based improvements in patient satisfaction scores, medical outcomes, people development, and corporate shared services and clinical processes Revealing practical techniques that can be adopted at all levels of an organization, from facilities manager to HR manager to CFO to CEO, Corporate Performance Management Best Practices provides a proven implementation model that accelerates breakthrough results.

“This book is a great addition to the field of ambulatory practice. The variety of its topics are a plus for those seeking to enhance their ambulatory practice. Ambulatory services are a sign of the times and the authors have sculpted a leading way into being lean and successful with outpatient care. This book has the potential to help practices nationwide." ---Doody's Review Service, 3 stars Designed for both the healthcare management student and the health professional entering or navigating a career in this growing sector of the U.S. health system, The Well-Managed Ambulatory Practice is a comprehensive yet practical resource covering the essentials of management unique and specific to the ambulatory setting. Written by leaders in the field with featured contributions from expert ambulatory care administrators and practicing physicians, this textbook offers tools, cases, and other applications to arm students of health administration, public health, business, medicine, and other health professions with the knowledge and skills for the delivery of more efficient and effective patient care. As the singular reference to managing ambulatory care in outpatient clinics, medical practices, community health centers, and other settings, the textbook describes the evolution of ambulatory care as a significant source of health care services delivery, its continued expansion in the marketplace, and its prominence in population health management, telemedicine, and other service delivery strategies. This text provides the reader with a thorough review of core functional areas of healthcare management through the lens of managing an ambulatory practice, including strategy and leadership; organizational structure; quality, safety, and patient experience; operations; financial management; and human resources. Chapters provide complementary teaching tools and case studies to highlight real-world examples that students and professionals may encounter in practice. Cases investigate topics such as preventive health, healthcare leadership, quality measurement, disruptive physicians, patient flow, operating procedures and metrics, and lessons from COVID-19 among many more. Key Features: Describes the core areas of health management through the lens of leading an ambulatory network or managing an ambulatory practice — strategy and leadership; organizational structure; quality, safety, and experience; operations; financial management; and human resources Provides expert strategies and best practices for managing a diverse array of ambulatory care settings, including outpatient clinics, physician practices, community health centers, medical homes, and more Highlights real-world case studies that students and health professionals may encounter in practice Purchase includes digital access for use on most mobile devices or computers, as well as full suite of instructor resources with Instructor's Manual, PowerPoint slides, and test bank

While the industry continues to undergo growing pains, transitioning to value-based care from fee-for-service, hospitals and providers are also fielding new challenges that have emerged on the regulatory, technology, and patient-consumer fronts. Hospitals and providers are in a race against one another to find new ways to attract and retain patients. Now that patients are assuming greater financial responsibility for their healthcare costs, whether voluntarily or involuntarily, their expectations are high about having a positive clinical and financial experience. Therefore, the engagement of patients should begin before the actual clinical encounter. The RCM departments of forward-thinking organizations recognize that an active patient engagement strategy is an effective way of influencing positive patient payment behaviors.Revenue cycle plays an intrinsic role in the overall patient experience, and there are multiple touchpoints by which to engage patients before billing them. Some examples include being transparent with patients at the outset about their financial obligations, removing barriers to payment by providing flexible options and payment tools, such as an online payment portal, and enhancing the design of billing statements. Patient engagement that prioritizes consumer satisfaction can lead to good financial outcomes for healthcare organizations.This book will help RCM professionals navigate the changing environment successfully.

It is easy to get lost in all the phases of revenue management, so how does a practice keep it all straight? Proven solutions to optimize revenue cycle are the key, and this primer is a business-critical resource to deliver just that.