Taming the Revenue Cycle Management Beast

For hospitals and health networks, revenue cycle management largely depends on the time-to-bill for procedures and diagnostic care. The faster they code and bill a procedure, the faster they are paid. Yet many organizations still struggle to turn around coding and billing in a timely manner.

Revenue cycle managementTo remove unnecessary bottlenecks and streamline the coding process, many organizations have moved towards same-day billing practices made possible by automated procedure documentation and coding solutions. These solutions remove unnecessary administrative layers and ensure complete, accurate and granular documentation to support reimbursement at the highest appropriate rate.

Challenges to Revenue Cycle Management
Manual processes such as dictation and transcription often carry much of the blame for sluggish revenue cycles. They can result in unclear, incomplete or illegible documentation, leaving coders guessing and increasing the incidence of error and the likelihood of rejected or denied claims.

Doctor dictationBest practices indicate that when documentation gaps exist, coders query the performing physician for clarification, which presents its own set of challenges. For instance, queries often come days or even weeks after a procedure takes place, making it difficult for physicians to accurately recall details.

Reliance on manual input by multiple people also gives rise to the issue of inconsistent documentation and coding, which further delays billing and, as a consequence, reimbursement.

Automated Documentation and Coding
To overcome the challenges inherent to manual dictation and transcription processes, a number of organizations are implementing structured reporting and coding technology to automate procedure documentation and streamline billing and reimbursement.

The ideal solution is one that can easily integrate with other clinical and financial systems, eliminating the need for major system upgrades, software modifications or manual mapping. Featuring intuitive navigation, these solutions lead clinicians through the procedure documentation process to efficiently and automatically tie documentation to reimbursement coding. This enables physicians to drive revenue recovery, as well as provides greater protection against audits. Structured reporting functions also streamline compliance with CMS initiatives and pave the way for participating in a wide range of quality programs.

Realizing Same-Day Billing
For many, these solutions also reduce the time-to-bill from weeks (in some cases months) to a day. In many cases, procedures are being billed within just minutes of completion, thus drastically improving the revenue cycle and ensuring that providers are being paid for their services as quickly as possible.

Such was the case for a large not-for-profit medical center in Portsmouth, Ohio. For years, the organization utilized cardiology-specific procedure documentation as part of its full-scale cardiology system. However, while the system supplied cardiologists with a diagram to support procedure documentation, it ultimately created a number of challenges to their process.

For instance, the diagram did not include the level of detail necessary for certain cardiology procedures forcing cardiologists to manually enter free text in their notes. In addition, several cardiologists still utilized voice dictation for procedures that were not supported by the system, such as intra-aortic balloon pumps or pericardiocentesis. As a result, coders often did not have the comprehensive documentation needed to bill procedures at the proper levels without going querying the cardiologist.

The organization resolved these issues by implementing ProVation® MD, which streamlined coding and billing and improve revenue cycle management. Since deployment, the center has seen an increase in the quality of documentation as well as coding turn-around time, which is now just minutes rather than days or weeks.

The Future with ICD-10
The challenges to revenue cycle management will increase as hospitals begin to code procedures in ICD-10. With the more granular code set comes more opportunity for error, thus increasing the likelihood for delayed billing and, by extension, delayed payment.

That is why organizations must streamline these processes now. By automating procedure documentation and coding, healthcare organizations can pave the way for a smooth transition and protect all revenue they are rightfully owed.


Learn how Golden Ridge Surgery Center uses automated documentation and coding to improve revenue cycle management. Download the case study.