Top of mind for most health system operations teams is the optimization of revenue cycle management (RCM). This critical starting point serves as a lynchpin for the success and profitability of the organization, helping to track and predict cash flow, process claims, and propel the business forward.
But RCM affects more than just the bottom line. To efficiently reduce claim and billing error, proper patient communication and data processing is key from the start. The details collected as part of the intake process lay the groundwork for patient interactions beyond billing. They set the stage for care efficiency, quality, and integrity.
While health information management (HIM) and RCM rely on digital records full of diagnoses and billing codes, each system entry represents a person in need of correct care. Errors introduced into either process can spell disaster for patient outcomes, result in decisions based on inaccurate figures, and leave health systems searching for lost revenue.
So, what can be done to mitigate the risk and errors associated with HIM, which, in turn, mitigates risk and errors for RCM?
Designing HIM Processes that Benefit Patients and Providers
It starts by looking at how your current data is being collected. Reliance on manual data entry is a recipe for error introduction. More and more providers are making the switch to electronic patient enrollment forms to start RCM and HIM off right by collecting patient data before they set foot in a medical office. This can standardize the format of patient data collection, as well as meet HIPAA and other compliance regulations for information handling and access.
Integrating HIM with electronic medical records/electronic health records (EMR/EHR) management is also critical to error reduction. Many of these systems were originally developed in silos, creating difficulties for HIM staff when it comes to access and reporting. By bringing together these solutions with workflows or triggers, you can close gaps between the patient’s intake details, a provider’s notes and diagnosis, and the coding and billing processes.
Team training is also critical here. ICD-10 codes can be quite nuanced, and the right selection based on provider assessment of patient health plays a key part in both patient outcomes and provider reimbursement. Medical record documentation and coding must have a high degree of detail and accuracy. Staff and health systems stand to benefit from regular training in the latest AHIMA and AAPC standards to maximize returns.
Technology also provides an assist. Machine learning and artificial intelligence can be integrated into HIM processes to check for discrepancies, flag records for review, and alert administrators of potential issues before they hit the claims department.
HIM Success Stems from Quality and Confidential Data Capture From All Angles
Drivers for HIM processes tend to center around internal gains and process requirements. After all, providers need to move records through a system to keep operations running smoothly. That said, manual data entry and review processes can introduce problematic errors with a direct impact on patient care.
Optimizing HIM with tech-based systems and RCM integration can cut down on costly mistakes for all involved. By recalibrating a HIM approach to be patient centric rather than process centric, health system reporting and RCM benefit, as well.
Accuracy for Treatment
When you think of HIM, first to mind is usually medical coding for claim reimbursement. But this affects more than just billing, although it has a significant impact on RCM outcomes. It also dictates next steps in patient care, approvals for diagnostic testing, prescribed medications, and referrals.
A staggering 86% of errors in the healthcare industry are administrative. With proper checks and balances, many of these preventable mistakes could be eliminated. Incorrect medical coding can indicate incorrect health needs, creating a domino effect of unnecessary testing, treatments, and transactions.
Analysis in Data Trends
Coding provides health systems with insights on patient care trends in a community. But if the data entered into HIM databases or reviewed by HIM teams is inaccurate, understanding of patient populations will be too. Standardizing everything from appointment setting to field selections can help paint a more accurate picture of more than just endemic ailments. Health systems can track efficacy across care providers and extrapolate what works – and what doesn’t – in specific patient care outcomes.
Assessment of Organizational Health
Of course, HIM does roll right into RCM and the impact on billing. With misinformation from the start, health systems can expect to see a rise in insurance claim denials, most of which are timely to review and resubmit. Instead, standardizing data input and controlling processes for review with humans and technology paired together can limit errors from emerging. Leadership can then have a more accurate understanding of business financial health to drive decision making and planning with real numbers.
Designing HIM Processes that Benefit Patients and Providers
HIM optimization is no small task or topic and overlooking it all together can lead to costly business process breakdowns. To fend off a collision between HIM, RCM, and the patient experience, HIM processes can be evaluated and adjusted using the following guidelines:
- Defining data needs: Medical coding does not exist in isolation. Instead, it should be analyzed in context of source, definition, and pairing with business costs and patient care. Where IDC terminology evolves, many HIM processes and data input approaches remain laggard or mismatched. By reevaluating system-wide data needs, you can restructure what you capture to also optimize the quality of what you capture.
- Identifying patient vulnerabilities: If data drives decisions, then patient data must crucially remain accurate to drive correct decision making. To this end, HIM teams can evaluate not only claim denial reasons, but also whether billing coding correctly corresponds to diagnosis and medical coding in the first place. This allows HIM to become a patient advocate, instilling trust and retention that can provide returns for RCM.
- Implementing compliance: Yet another broad term with precise ramifications, compliance must be prioritized across workflows. Technology can be used to safeguard data access and notify key personnel in the event of errors that could be inadvertently fraudulent. Opportunities for collaboration and transparency can also help members of different teams to work together to question decisions and find the best resolution to any discrepancy.
GeBBS partners with leading health systems to optimize HIM processes through a combination of human and technology-driven solutions. Expert medical coding and billing personnel work within customer tech stacks and workflows to supplement processes with accredited experience. The result is compliant, accurate data that can better drive business decisions, patient care, and revenue management. Contact the team at GeBBS today for a free consultation about the variety of HIM solutions available for your healthcare organization.