Revenue Cycle

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    Has anyone looked at the revenue cycle, particularily for an area like the CATH Lab? I have over 4k accounts from 2002 to look at, but can’t seem to narrow it down to what consititues a defect. There are so many variables in this process as with all revenue cycles. I’d sure like some input if anyone else has done a similar project. 



    There are a couple of ways to start breaking it down.  You can segment it by  (1.) 3rd party payor  (2.) age (3.) type of rejection: demographic data, payor information,  procedure coding, no response (usually private pay). 
    Once you’ve segmented then you will still need to look at the type of rejection to get to a measurable error. Demographic and payor data is usually obtained in the registration process. Identify the types of errors (mispelled names, wrong addresses, wrong payor, workmen’s comp carrier not identified, referring MD, etc).  Coding comes out of the clinical representation of the procedure by MD and Tech. The coding process carries its own set of missing or mis-entered information (delays in billing often come from the coder having to search for the data).  The oldest accounts (age) can give you an indication of not only the record errors that lead to rejection but the errors in the billing/rebilling process that lead to ageing of a bill.  
    I would take a sample of the rejections to determine where I thought the errors with the most impact on  revenue occurred.  Then test my assumptions against the total sample.  This assumes you can do it electronically.  If it is a manual process – I would definitely do a quick sample and then move to the looking at whether I can apply what I have learned to the present processes so as to short circuit the backlog of unpaid accounts.

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