The issue is the efficacy of prevention versus correction, to which the latter appears to be more prevalent in healthcare.
Over the past couple of years, I have been concerned that the healthcare industry seems to spend more time, money, and effort on correction instead of prevention.
Our entire healthcare system focuses more on treating disease and illnesses, although there is a much stronger push towards preventative medicine. In my present roles, I have seen this concept of correction in clinical revenue cycle far surpass that of prevention.
There are several major industries that have put in place processes of prevention. These included the following:
Prevention does not happen overnight. It takes planning and a process. One of the biggest areas where correction is the pre-eminent process is denials management. How would one go about denials prevention? We are better than “scrubbers,” and artificial intelligence. If we utilize these tools properly, they can serve as our prevention. Start with a problem-solving process.
All these steps can be used in utilization review, CDI, and coding and other areas of healthcare. Think about it this way and in a simple stepwise direction:
I once had a CEO that looked to see how many ways can things go wrong from the point of an order placed for a complete blood count (CBC) to the point where the result appeared on the chart. He came up with over 300 possible areas/events. That is one simple event in a hospitalization.
Multiply that by all that happens in a hospitalization and trying to get it all summarized on a UB-04. One might say that healthcare is too complicated. Really! How complicated was it to put a person on the moon?
Let your outputs determine your outcomes.
Will you focus on correction or prevention? It’s a process, and a process is a series of events leading to a desired result. For my hospitals I will be focusing on prevention.
What about you?
While attending the Florida Compliance and Privacy Consortium meeting, I was asked an excellent question. What if a patient who is ready for discharge from
External audit volume more than doubled in 2024 over 2023, while total at-risk dollars increased fivefold to $11.2 million, according to a report outlining a
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