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Clinical Documentation Integrity Significance in Revenue Cycle Management Success in Healthcare

Clinical Documentation Integrity Significance in Revenue Cycle Management Success in Healthcare

Revenue Cycle Management (RCM) can be thought of as the method of transportation to take an organization from one place to where it needs to go. For the transport to occur successfully and be operationally sound, the processes in place to support it must be accurate and deliberate. The chances of the vehicle making it to the destination with a missing tire would predispose the outcome to failure. So is the case with clinical documentation deficiencies.

The Healthcare Financial Management Association (HFMA) defines the revenue cycle as “All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” Clearly, what this description is stating is that the success of this operation of people and processes being successful is dependent upon the vital information being accurately recorded for claim generation, claim submission, and full payment recompense. Anything short of these two operational necessities working collaboratively, will predispose the organization to denials.

Best Practices for Getting it Right the First Time

Perhaps the most vulnerable of issues in the RCM process is the potential for incorrect information creation in a patient’s chart. Data disparities duplicate or inaccurate medical record number recording, and unverified insurance verifications processes in place can potentiate claim denials. By the establishment of best practice procedures designed for guidance at registrations time, the opportunity for errors and oversights can decrease significantly. As a best practice, providing accurate claims data to assist in the appropriate coding, has a direct impact on decreasing denials and improving financial cash flow.

In short, a better way to say it: error-free claims + accurate coding = denials avoided = money unlost!

An important best practice decision that your organization can undertake is to work with YES HIM Consulting, Inc. as their professional coding partner. Successful results take proactive measures, and YES auditors can identify outliers that can have an impact on your organization’s coding accuracy, revenue, and data quality. YES auditors keenly identify potential deficiencies upfront and create a custom quality improvement plan per coding challenges. Working with our partners in order to establish streamlined processes with built-in measures, to capture and alert of a potential error before claim submission. The objective is clear: revenue “protection” while maintaining compliance standards. We have provided a brief overview of the importance of ICD-10 coding in the RCM process here.

The Final Important Takeaway

The objective and need for sound clinical documentation integrity cannot be overstated. The key to effective error reduction and claims denials in any organization may be as simple as to identify them before they occur. This standard set of safeguard protocols put in place early on will further mitigate any significant unbilled list of claims. This guiding rule employed early on will help to eliminate the potential slowing of cash flow for the organization.

Mari Cely

Director, Business Strategy & Marketing
Revenue Cycle Management

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