Learn the Real Driver of Revenue: The Clinical Revenue Cycle

The clinical revenue cycle (CRC) is a little-known, but highly essential, facet of the overall revenue picture for hospitals, accounting for a large portion of costs associated with patient care. Gaining a clear and practical understanding of the CRC must start with a recognition of the need to improve its performance in relation to the revenue cycle.

During this groundbreaking ICD10monitor webcast, our presenter, Dr. John Zelem, will explain in easy-to-grasp terms the importance of the CRC, empowering you to realize unrecorded, but rightfully earned, revenue for your facility. You’ll learn about the CRC’s intricacies and internal processes, as well as its impact on managing the direct and indirect costs of providing patient care and maintaining a sustainable revenue stream. Critical considerations include proper determination of the defendable level of care and the documentation needed to support inpatient care. Ultimately, specificity in the documentation translates to billing accuracy, reducing the risk of denials.

From this webcast, you’ll learn about five key CRC components:

• Utilization review
• Care/case management
• Clinical documentation integrity (CDI)
• Physician advisory
• Coding

An overarching weakness in many organizations is that these components tend to operate in silos, interfering with knowledge-sharing and collaboration among teams — which results in territorialism. Silos aren’t necessarily bad and tend to be inherent in healthcare. However, the individuals involved with these silos are inclined to view physician documentation through their own lenses. In the context of the CRC, it’s vitally important that these silos be broken down and rebuilt with a holistic approach.

Why This is Relevant:

Hospital and healthcare system margins have decreased recently, especially over the past year. Sustainable income is being challenged all the time with decreasing reimbursements, coupled with aggressive auditing and denials. The CDI team has the responsibility to improve patient healthcare records to ensure improved patient outcomes and data quality, leading to accurate reimbursement. Documentation that doesn’t support an acute level of care will result in denials and loss of rightfully earned revenue.

Take this brief quiz to see if you and your team could benefit from this webcast:

1. Does your revenue cycle management process reflect the significant impact of the clinical side on revenue preservation?
2. Do you know the delta for your average inpatient vs. observation reimbursement, both by Medicare and a commercial payer?
3. Do you have utilization review coverage seven days per week?
4. What cross-functional capabilities and knowledge sharing exists between your CDI pro-gram and coders?

Learning Objectives:

• Understand the clinical revenue cycle and where it belongs in revenue cycle management
• Identify components of the CRC and the role each one plays
• Learn how to balance CRC components, which are asymmetrical by nature, to prevent unintended negative consequences
• Understand how filling knowledge gaps can reduce denials and improve documentation
• Learn how to holistically position the CRC for success, using techniques such as team empowerment, cross-functionality and knowledge sharing

Who Should Attend:

Chief financial officer, revenue cycle vice president, physician advisor, case management director, and staff involved with coding, finance, patient finance and CDI.