Hospital-Based Physicians and Revenue Cycle Management

When we talk about revenue cycle management systems it’s easiest to draw comparisons to physicians working in an ambulatory setting. This setting allows for accurate and timely charge capture of fees by their electronic medical record system.

When we talk about revenue cycle management systems it’s easiest to draw comparisons to physicians working in an ambulatory setting. This setting allows for accurate and timely charge capture of fees by their electronic medical record system. However, their inpatient counterpart physicians are less likely to reap the benefits of the EMR’s billing functions – if they’re reaping the benefits of an EMR at all.

Reasons charge capture for fees is challenging in an inpatient setting:

• The physicians are less likely to be hospital employed (instead, they may be contracted to hospitals as a group)
• The EMRs may not be on-site, or, if no EMR is present currently, the billing may be spread out across multiple third-party companies.
• There are conflicting priorities in a hospital setting: the hospital is more concerned with facility charges than physician fees. 

There’s always a bit of a push and pull between hospital and physician priorities. Hospital decision making- especially when it comes to new technology – is far more focused on the bottom line than it is ease of use and benefi,t specifically for physicians. This can create problems for professional fee capture – and leaves it up to the individual physician to figure out. What further complicates this is the simple fact that most hospitals are not entirely electronic – at best, they are working out of a hybrid paper-computer chart and therefore, much of the documentation for an inpatient is going to still be paper-based. This is likely to include types of documentation unique to inpatient physicians, like hospitalist progress notes. When you consider the relative ease of checking electronic documentation for compliance, it becomes immediately obvious how paper charting throws a wrench in one’s measures of documentation compliance. Errors, then, are less likely to be caught while they can still be amended, and money is lost – not just for the physician, but many times, the hospital as well.

Strategies for Process Improvement / Revenue Cycle Management

The first, and perhaps most important, step is to recognize that different healthcare systems – and even different hospitals within the healthcare system, will need to focus on different areas of their revenue cycle. There likely is not one common theme of focus for everyone; this is largely due to variations in size and patient demographics. In simple terms, hospitals need to identify what is most important to the success of their organization early on, and then continue to put their efforts into it in order to continuously improve. Then, they need to make known to everyone in the organization that the management of the revenue cycle is important – and everyone has shared responsibility in it. 

In the C-Suite, the expectation for revenue cycle performance should be set high. This, then, needs to be supported through economic investment in training and compensation for those who are held most responsible for the ongoing success of the cycle. At times, this may require “outside the box thinking” and the innovation of new metrics for measuring performance. As the process evolves, old standalone methods may no longer yield accurate results.

For physicians, not only do they need to trained on the inner workings of the revenue cycle they will be at the will of, but they also need to be able to quickly identify errors. In most cases, a willingness to pay attention to the revenue cycle may be enough – but in other cases, more of an intellectual investment may need to be made.

Incentives for learning these strategies and paying attention may help to keep everyone, from the C-Suite down, accountable for their piece of the revenue cycle puzzle. Communication between all stakeholders is invaluable for the success of the revenue cycle – to not communicate is to continue to allow various parts of the cycle to operate in silos, which breeds misinformation, mistakes and in many cases, resentment of processes that are in theory very strong – and may only be viewed as challenging and ineffective because of a distinct lack of communication among key members.

Ongoing discussion and re-evaluation will likely be necessary, but there are resources aplenty for organizations and physicians who are looking to make changes and improvements.