The following slides are from: Healthcare Revenue Cycle Basics MED INF and are credited to Jennifer Andersson Jennifer Van Dyke Session #8 Revenue Cycle Information Technology – Hospital Trends

2 Collections Follow-up Billing Medical Records Charge Entry CUSTOMER SERVICE INFORMATION SYSTEMS & INFRASTRUCTURE Registration Authorization Verification Scheduling Managed Care Care Coordi- nation Remit/ Cash Posting Inadequate training and accountability of patient access personnel Not being managed with a revenue maximization and denial avoidance mentality Inadequate insurance and patient follow-up creates cash flow difficulties Billers not retrained to function like collectors Information systems personnel who do not understand patient accounting Uncoded backlogs building up - delayed billings Inadequate relationships with payors Bad Information Rework Chargemaster not updated to address billing errors and payor specific requirements What are the Process Breakdowns?

3 Authorization / Verification Online and real-time systems to confirm: eligibility, pre-certification, authorization, verification, referrals. Online, real-time, verification of benefit plan coverage and limitations. Automatic confirmation of insurance information and expected out-of- pocket contributions. Charge Entry Integration of order and charge entry (no dual entry), including edits for completeness and accurateness of billing information. Billing Real-time billing integrated with collection upon patient checkout. Predicted collectability of individual bills. Edit for claim accuracy & completeness prior to posting. Collections/Follow-up Prioritize collection based on amount and ability to pay. Remittance / Cash Posting Online payment via credit card. Automatic re-submission of denied claims. Real-time claim adjudication. Scheduling/Registration Multiple schedule & registration entry points. Common front-end for registration and scheduling. Integration with authorization & verification process. I.e. Gather necessary insurance and demographic information at the point of entry. Automated appointment confirmation. Customer Service (call center) Tracking system to categorize correspondence in order to create automation tools. New telephony system to reduce response times. Future Revenue Cycle Technology Vision Collections Follow-up Billing Medical Records Charge Entry CUSTOMER SERVICE INFORMATION SYSTEMS & INFRASTRUCTURE Registration Authorization Verification Scheduling Managed Care Care Coordi- nation Remit/ Cash Posting