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HIM Department Gets Involved in Revenue Cycle

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The health information management (HIM) staff for Halifax Medical Center plays a significant roll in the revenue cycle management process for its parent organization, Halifax Fish Community Health (HFCH), located in Daytona Beach, FL. HFCH is the partnership between the Southeast Volusia and the Halifax Medical Center Taxing Districts. Patient Business and Financial Services (PBFS) is an affiliate company of the partnership. PBFS combines the revenue cycle operations of the two organizations to serve both Halifax Medical Center and Bert Fish Medical Center, with specialized revenue cycle expertise that neither organization could afford or support on their own.

The functions included in PBFS are as follows: HIM; patient scheduling; patient access; financial counseling; billing; customer service; credit and collections; cash applications; resource and case management; managed care contracting and modeling; and information technology. We see the revenue cycle from pre-registration through collections, front end through backend, including contract negotiations, in an attempt to turn our workflow processes into revenue.

Process

As you can see, the HIM department at HMC is part of the business called PBFS, under the Halifax Fish Community Health umbrella. We are proud of the successes we have experienced as part of the team, and we continually strive to improve our performance for Halifax Fish Community Health. We have three distinct locations, and we've been able to maximize management expertise from the three locations into one location, allowing for more specialization.

The program functions with an incentive bonus program, awarding staff for target based performance. The management staff, made up of 18 managers, directors and the vice president, meets biweekly to discuss goals, objectives, process improvement, targets, accomplishments and projects. Supervisors from all areas meet once a month for open discussion and problem-solving sessions, with the goal to improve workflows and processes that will help us to have a positive impact on our bottom line. One of the team goals is to remove roadblocks for staff to reach their full potential. Roles have been defined, goals have been set, and tools are provided to get the job done effectively. Our environment allows for everyone to express new ideas, and staff is encouraged to be creative in their thinking. All ideas are considered important.

Cash flow has improved significantly, and we have greatly reduced our accounts receivable (A/R). We have been able to significantly reduce claim denials, requests for corrected claims and financial loss. The PBFS staff gets the credit for improving cash flow over last year and is on track to increase that number again this year. Our A/R days are 55.4. The success of the PBFS team has created a strong foundation to support the growth of Halifax Fish Community Health.

In an effort to reduce late charges, we have established a sub-team that regularly assesses the issue of "late charges." The team, consisting of key staff from compliance, finance and PBFS (coding manager and business office manager), along with input from the clinical department managers, has been instrumental in the design of NPR reports, enabling the managers to audit their late charges as frequently as they desire and providing them with a monthly status report of same.

The HIM staff all play a significant roll in the revenue cycle management process. We have experts in coding, who lead and educate. They are proactive in monitoring OCE/CCI edits, significantly reducing the number of claims rejections. Our coding manager participates as part of a PBFS charge description master sub-team, working very closely with the clinical department managers, assisting and educating them in whatever way we can, helping them to understand how their process impacts revenue. We encourage and support clinical participation in the process. We value their cooperation.

Our release of information staff work very closely with patient accounting in designing and following work flows that will facilitate timely and efficient turnaround of requests for information, to get the claim out the door more quickly and/or to answer payer requests. Priorities have been established, and NPR reports have been designed to improve the process, eliminating a lot of unnecessary phone calls among the staff. We do as much up front as possible to expedite accurate billing and reimbursement. Doing it right the first time is one of our strategic goals.

Transcription understands how important it is that reports are accurately transcribed and available as quickly as possible, both for patient care and for reimbursement.

The HIM customer service staff is instrumental in expediting the requests for the case management and resource management staff in dealing with discharges and denials. It is a concurrent process as well as retrospective. The customer service staff has clearly delineated lines of responsibility and understands that follow-up is essential. The lines of communication between the case management staff and the HIM customer service staff are clear and concise.

The HIM staff knows and understands their roll in revenue cycle management, and as such recognizes their importance. They take pride in their contribution. They are able to experience many successes, big and small, and they are recognized for the part they play in the process.

We are a business. We look for the best methods to get the job done in a cost-effective manner. We constantly analyze the systems and software we use in our individual PBFS departments, in an effort to improve what the system can do for us. As PBFS employees, we work as a team for the good of the organization. Team spirit is demonstrated and encouraged, and each member of our staff is recognized by their individual strengths that support the team. We function as leaders within our organization.

Betty Garard is director of the HIM department at Halifax Medical Center, Daytona Beach, FL.


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