HIM professionals touch many functions of the revenue cycle.
As we continue this segment on health information management (HIM) in the revenue cycle, I’d like to share some thoughts I discussed at the recent Missouri Health Information Management meeting.
When we think about the functions that compose the revenue cycle: financial counseling/pre-registration, pre-admission testing, access, case management, HIM and coding, and patient financial services (PFS) including CDM, we are already involved in each of them!
Often times we provide the data to develop the grid for procedure prices that are used by the pre-reg team to share with self-paying patients, we assess the pre-admission testing and the results to determine if the testing is related to the inpatient care,we work with access to clean the demographic data, case management uses our working DRG in some cases and we help both the internal and external case managers to obtain some of the clinical information needed to support the status, and of course, we’re connected at the hip with PFS to ensure the coding is consistent with the charges and that CDM driven charges are consistent with the coding and documentation in the record.
HIM has other skills that are ideally aligned with managing the revenue cycle. These include the following:
We’re a feisty bunch and no one can fight a coding denial better than we can! So, that brings us to our next topic: What are the characteristics of a good appeal letter?
Finally, when it’s all said and done, ensure your claim system and the payer’s claim system reflects the final set of agreed-upon codes for data integrity and the patient’s profile purposes.
Programming Note
Listen to Rose Dunn report this story live today during Talk Ten Tuesdays, 10-10:30 a.m. ET
EDITOR’S NOTE: The author of this article used AI-assisted tools in its composition, but all content, analysis, and conclusions were based on the author’s professional
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