Revenue Cycle

Tip: Real-life examples of revenue-cycle team initiatives

Patient Financial Services Weekly Advisor, January 7, 2005

Saving revenue and cost can show up in unlikely places. Craig Stumpenhorst, assistant director of business services at San Antonio Community Hospital in Upland, CA, gave the following example during a December Webinar hosted by 3M Health Information Systems.

The hospital made it standard practice to give guest trays to family members and friends who wanted to stay with their children. "We were having our dietary department track those charges so we knew how much we were spending. We looked and said, 'is this really important?'

"There were people in the dietary department, on the floor, and in patient accounting who were handling charges and creating bills that we're really not doing anything with. So we changed our policy. We said we'll give one guest tray per family member per shift and did away with charging for it. That showed both a labor and cost savings."

This new policy was the result of the facility's revenue-cycle task force, cochaired by Stumpenhorst and Monica Lenahan, CCS, manager of coding services.

The first major task was developing APC implementation strategies, and the first priority was to make sure the chargemaster was up to date, understandable, and clean.

"We brought in an outside consultant to do a review of the departments we felt had the most issues with high volume or problems-issues brought up by coders and billers. We did a complete review of every line item in the department, then we met with the department and reviewed everything line by line."

It's crucial to go through the details and not rely only on a big-picture review, Stumpenhorst says. "We found that those departments had charges that were much different from our interpretation; pricing, duplicate pricing, etc. It really will make life easier to take the time and do a chargemaster review."

The team then determined it needed to do the following:

  • Explore staff training opportunities. Coders needed to learn more about CPT and revenue codes and line item charges. Billers needed to learn more about modifiers and how diagnosis procedures under the new rules could impact reimbursement.
  • Educate staff. Stumpenhorst says he trained staff on a variety of topics, from implementation of ABN checker to monitoring and coding and billing issues as they arose. "We worked to look for resolution," he says.
  • Develop a revenue coordinator position. "It quickly became apparent that we needed an individual to be the point person for all the changes coming down from CMS and fiscal intermediaries," Stumpenhorst says. "We needed someone familiar with coding, with a billing background, who has an understanding with the chargemaster." The hospital ended up moving a manager from the billing office who oversaw government accounts into the new position.

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