While hospital revenue cycles are unique, we can try to replicate “normal” businesses as best as we can. When you go to the grocery store and put your groceries up for check out, you pay for what you pulled off the shelves at that moment. Have you ever been asked for a modifier for the bananas when checking out at the grocery store? 

You see where I am going here. 

We all know this is not the way healthcare works. Correct me if I am wrong, but healthcare is the only industry where we are translating services provided into a code and sending that information off to insurance companies in hopes of being paid. We don’t send them an invoice that says, “Office Visit” and they pay us $100. Perhaps in many years’ past, it was a lot more like this, but it has gotten increasingly more complicated. I am not describing anything new – we all know the struggles of getting paid in healthcare.

My recommendation from my experience as a previous Revenue Cycle Director would be to have your revenue cycle mirror operations when possible. What I mean by this is make sure that everyone in revenue cycle understands what is happening operationally. Additionally, be sure that the employees working in operations understand that everything they do, every button they press, is contributing to creating the cryptic invoice that insurance companies will be receiving. When operations and revenue cycle work hand in hand you are far more likely to combat all the internal issues that end up in denials. It will allow you to focus on the areas externally that create their own separate set of issues. 

The highlight of my revenue cycle career was an Epic GoLive in 2014. The team I worked with in the revenue cycle was amazing. Everyone knew their role AND they engaged the clinical departments in the build. Everyone was on the same page about what happened in operations equaled what was going on the claims. Our accounts receivable never spiked and we never lost steam. Our CFO was pleased, and it was perfect to say the least. We felt like revenue cycle champions. Investing time in making sure that there is clear understanding between clinical teams and revenue cycle teams is more than worthwhile. 

When operations and revenue cycle walk hand in hand through the daily functions of a hospital, you will be far better off than working in silos. 

Have questions for Danae?