Revenue Cycle Management and Business Office (BO) Processes

Hospital Best Practices and Recommended Strategies

The tools below assist leaders with improving revenue cycle processes and increasing business office efficiency, which results in positive financial benefits due to quick course correction, increased reimbursement and clean claims to ensure "money is not left on the table”.

Revenue Cycle and Business Office Process Improvements

  • Access DRCHSD BKD Billing/Coding Bootcamp, a virtual bootcamp consists of three interactive webinar recordings. Each webinar is composed of 2-hour sessions. The first webinar is Rural Hospital focused, and the second and third are focused on Rural Health Clinic (RHC) billing and coding. Training Topics include:
    • Compliance
    • ICD-10-CM coding
    • Current Procedural Terminology (CPT) coding
    • Modifier usage
    • Emergency Department (ED) Charge Capture
    • Outpatient Observation Charge Capture
    • Infusions and Injections
  • Implement best practices checklist referenced in the Revenue cycle management (RCM) Best Practice Guide to increase reimbursement and improve efficiency and BO functionality. Have staff use the sample scripting in the guide to increase point of service (POS) collections.
  • Hold weekly revenue cycle management (RCM) meetings
  • Use key performance indicators (KPIs) to drive RCM discussions and department meetings
  • Perform regular reviews and updates of the charge master
  • Review and update policy and procedures for BO processes, particularly POS collections
  • Establish a minimum payment plan
  • Implement concurrent coding and educate the UR nurse / care management team on CMS ICD-10 coding to increase accuracy and efficiency in medical necessity documentation and billing. Use CMS ICD-10 Code Lookup
  • Implement a daily chart review process to ensure medical necessity criteria is met
  • For each registration clerk, create a report of items that are being tracked for them individually. This might include cash collections and registration errors. Provide follow up with the goal of moving them towards improvement
  • Follow up with department heads about late charges
  • Use the Templates For Charity Care And Bad Debt to develop a charity application and policy guidelines.
  • Use the Understanding the Hospital Medicare Cost Report Uncompensated and Indigent Care Data Form CMS-2552-10 (Worksheet S-10) Guide to better prepare Worksheet S-10 and improve charity care and uncompensated care reporting
  • Ensure that bad debt claims between 120-150 days old are returned from the collection agency so that bad debt amounts can be included in the cost report
  • Increase compliance with Medicare by implementing a process to provide the Advanced Beneficiary Notice of Non-coverage (ABN) to Medicare patients in situations where Medicare payment is expected to be denied:
    • Ensure that Important Medicare Message (IMM) letters are provided and explained to the Medicare patients on admission to IP and prior to discharge
    • Ensure that HINN letters (Hospital-Issued Notices of Non-coverage) are provided and explained to Medicare patients prior to admission, at admission or at any point during an inpatient stay if the hospital determines that the care the beneficiary is receiving is not covered because it is not medically necessary

Revenue Cycle Key Performance Indicators

  • Track and monitor the key performance indicators (KPI) and implement evidenced-based strategies outlined by Healthcare Financial Management Association's (HFMA) Mapkeys to improve performance
  • At a minimum, rural hospitals should track and monitor the following rural relevant KPIs to improve revenue cycle performance:
    • Cash collected and cash percentage of net revenue
    • Gross accounts receivable (A/R) and gross A/R days
    • Net A/R and net A/R days
    • In-house and discharged not-final-billed receivables
    • Third party aging over 90 days
    • Cost to collect
    • Bad debt and charity as a percent of gross charge
    • Denials as a fraction of gross charges
    • Point of service collections as a fraction of goal

SRHT Project Success

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,560,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.