Revenue Cycle 
Revenue Cycle Education
Improvement Strategies
Presented by:
Colleen Malmgren, MS, RHIA
Fairview Health Services cmalmgrl @fairview.org
Definition of Revenue Cycle
All administrative and clinical functions that contribute to the capture, management and collection of patient service revenue
*HFMA
Scheduling/Registration Health Info Mgmt
Case Management
Pt Financial Srvcs
Charge Capture
Revenue Audit
Chargemaster
Establish Performance
Indicators
Establish measures that go beyond
Accounts receivable days (A/R days),
Discharged not Final Billed (DNFB)
Develop set of key indicators and graphs to communicate progress with revenue cycle improvements
Look at relationship between the indicators and the processes that affect the results
Typical Metrics / Measurements
A/R Days
DNFB
Bill Hold Days
# of query forms
# Charts missing documents required for coding
Case mix analysis
% of late charges
% of registration errors
% of clean claims
% of RTF's /Denials
% and $ amount of write offs
Measuring - Before & After
Measure where you are, and where you want to be
Helps identify specific areas of focus
Helps with identification of critical interactions and constraints
Know your baseline performance - then set realistic goals and initiate change
Establish Best Practice
Standards
Pre-registration rate of scheduled pts 95%
Insurance verification rate 95%
Collection of co-pays prior to service 95%
Bill hold days 3-4 days post discharge
Late charges as % of total charges <3%
Overall denial rate <4%
Appeals overturned at rate of >50%
Financial measures
HFMA members rated the following as the most important measures of revenue cycle performance: • Revenue / Cash flow
• Receivables / Days in AR
• Bad debt / write offs
• Denials / underpayments
• Performance by payer / contract performance Lowering DNFB - HIM strategies
Coding experience, with adequate staffing, crosstraining and well defined processes, policies and productivity expectations.
HIM staff engagement in physician
Improvement Strategies
Presented by:
Colleen Malmgren, MS, RHIA
Fairview Health Services cmalmgrl @fairview.org
Definition of Revenue Cycle
All administrative and clinical functions that contribute to the capture, management and collection of patient service revenue
*HFMA
Scheduling/Registration Health Info Mgmt
Case Management
Pt Financial Srvcs
Charge Capture
Revenue Audit
Chargemaster
Establish Performance
Indicators
Establish measures that go beyond
Accounts receivable days (A/R days),
Discharged not Final Billed (DNFB)
Develop set of key indicators and graphs to communicate progress with revenue cycle improvements
Look at relationship between the indicators and the processes that affect the results
Typical Metrics / Measurements
A/R Days
DNFB
Bill Hold Days
# of query forms
# Charts missing documents required for coding
Case mix analysis
% of late charges
% of registration errors
% of clean claims
% of RTF's /Denials
% and $ amount of write offs
Measuring - Before & After
Measure where you are, and where you want to be
Helps identify specific areas of focus
Helps with identification of critical interactions and constraints
Know your baseline performance - then set realistic goals and initiate change
Establish Best Practice
Standards
Pre-registration rate of scheduled pts 95%
Insurance verification rate 95%
Collection of co-pays prior to service 95%
Bill hold days 3-4 days post discharge
Late charges as % of total charges <3%
Overall denial rate <4%
Appeals overturned at rate of >50%
Financial measures
HFMA members rated the following as the most important measures of revenue cycle performance: • Revenue / Cash flow
• Receivables / Days in AR
• Bad debt / write offs
• Denials / underpayments
• Performance by payer / contract performance Lowering DNFB - HIM strategies
Coding experience, with adequate staffing, crosstraining and well defined processes, policies and productivity expectations.
HIM staff engagement in physician