A Newsletter for the Healthcare Information Systems Community. Published by HCS.
Health Care Software, Inc.
Issue No. 22 - Spring/Summer 2006
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President's LetterWho is in control of your revenue cycle? Usually third parties and fiscal intermediaries determine the amount and time when an organization will be reimbursed. This limitation stresses the importance of an integrated contract management application as part of the billing process. Terms, conditions and reimbursement relationships are often not known until payment is rendered. There is inherent value in understanding reimbursement terms for a majority of revenue sources. In order to do this, a revenue cycle management solution needs to be fully integrated with a contract management application. Stand-alone contracting applications are beneficial for analysis and profitability studies, but unless those terms dictate and drive how an organization will bill and collect, it remains separate. For each patient type, contract management must have the ability to build in rules, fees, codes, forms and edits to drive the billing and collection process. Once supported, the system can perform contractual adjustments at billing which specifies the total due from each payor source and outlines the real-time, real-net value to the organization. Upon remittance, billers determine if the amount received matches anticipated terms or pursue any discrepancy. The revenue cycle begins at preadmission/admitting and continues through the clinical process to billing and collection. What happens in the background of automated reimbursement rules in an integrated contract management suite creates a greater level of automation and targeted, accurate collections. With highest regards, |
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