For our finance strategic plan, we decided to focus on RCM revenue cycle management. XYZ care center will use RCM to become more efficient and cost-effective. Automated revenue cycles are used for efficiency through tracking patient eligibilities, editing ongoing claims, maker payer updates easy, pinpointing issues, gaining insight into denials and putting policies in place for providers to abide by.
Our first peer-reviewed article was “The integrated revenue cycle: Making the case for change” by McBride, S. According to McBride (2004) “health care institutions are finding it increasingly difficult to improve revenue-cycle performance. Current processes suffer from duplication of effort and overlapping responsibilities. Resources are not shared,…show more content… Revenue-cycle is unique in the sense we are able to combine various departments into one area. Departments consist of patient information, denial claims, clinical integration, documentation, billing and codes, and payments. This department can be located in one facility or located in various facilities. Typically, organizations will have an IT system for each process. Most IT systems run off various applications causing poor communication with other RCM’s. Information within the systems is stored amongst various buildings used for patient information pertaining to finance and…show more content… Their primary location in Danville, PA, it is a healthcare organization, including hospitals, primary care, physicians, and a health plan. According to GE Healthcare “Geisinger is a distinguished leader in RCM. Over the past five years, it has received the HFMA’s MAP award for high performance in the revenue cycle” (pg. 3).
With such success, Geisinger still had goals to accomplish. According to their vice president Geisinger needed to exclude back-office rework, maintain workflow and patients accounts. Her numbers obtained focus on accounts receivable days, cost to collect, net collections to revenue and key aspects of denials. One of their main focus was clean claims. Clean claims reduce errors from initially taking place, while understanding payer requirements, into one system.
Geisinger decided to use centricity business, this is an RCM system within GE Healthcare. This system focuses on outpatient operations, allowing Geisinger to attain effective results. GE Healthcare states “It’s net A/R days are now below 30, and its aged A/R is shorter than industry standards. Denials for medical necessity are less than 1% of claims. Its overall cost to collect is declining and now stands at 303%, which is lower than the budgeted amount of 3.5%. And the organization is collecting 100% of claims after accounting for bad debt and charity” (pg.
