2. 2016 Celebration of Health Information Professionals Week: The Patient Revenue Cycle Crystal Clack, MS, RHIA, CCS Director, Coding and Data Standards, AHIMA

3. Topics What is a Revenue Cycle? Stages of a Revenue Cycle What Non-Revenue Cycle Person Needs to Know The Health Information Professionals’ Role Conclusion

4. The Definition of a Revenue Cycle According to Revenue Cycle Management Best Practices by Nadina A. Davis, MBA, CIA, CPA, RHIA, CHDA, FAHIMA: “The revenue cycle refers to the series of activities that connect the services rendered by a healthcare provider with the methods by which the provider receives compensation for those services.”

5. Basic Stages of Revenue Cycle Patient Revenue Cycle Revenue Cycle Starts when Patient makes appointment Patient presents for appointment; provides insurance information Patient is seen by Provider Provider makes notes in patient chart Patient leaves/chart is reviewed by coder Claim submitted to patient’s insurance Insurance sends payment to accounts receivable. Account Paid.

6. Revenue Cycle Starts with Patient The Revenue cycle starts when a patient makes an appointment; or Presents for medical treatment

7. Patient Calls for an Appointment If a patient calls to schedule an appointment Scheduler will ask the following: 1.Has patient been seen before? 2.Chief complaint? 3.Name/Date of Birth/Contact Info (if new patient) 4.What is patient’s insurance? 5.When does patient want to be seen?

8. A Word About Numbers Medical Record Number – is a number assigned to patient by that specific practice. This same number will follow the patient throughout all visits with that practice Encounter Number – Sometimes referred to as Visit Number. This number is specific to the patient’s individual visit. It is only used once. All services for that specific visit fall under the encounter number.

9. Patient Presents for Appointment PATIENT PRESENTS FOR MEDICAL TREATMENT New Patient Name, contact information Insurance/Method of Payment Fills out registration forms, signs consent for treatment/HIPAA Collect Co-Payment Established Patient Copy of insurance card Signs consent for treatment/HIPAA Collect Co-Payment

10. While the Patient is Waiting… The registration specialist verifies and updates all patient information in computer’s registration system Patient is ready to be seen!

11. Patient is Seen by Provider / Office Provider meets with patient and performs pertinent exam(s)/test(s) Provider (or their scribe) records the information in the patient’s medical record

12. Patient is Seen by Provider / ER Provider meets with patient and performs pertinent exam Provider (or their scribe) records the information in the patient’s medical record Provider orders labs and other ancillary exams as needed to help determine diagnosis

13. Behind the Scenes After patient leaves, the provider reviews the medical record and performs any pertinent dictations; indicates the patient’s diagnosis; necessary follow-up etc.

14. Chart is Reviewed by Coder Specially trained Medical Coder reviews chart and assigns appropriate codes to chart based on documentation that provider noted in chart Critical step in the revenue cycle! Critical step in the revenue cycle! Patient was seen for contusions to bilateral extremities and elbows due to tripping over an alligator and then being sucked into a jet airplane engine; initial encounter.

15. G43.001 What is a Coder? A coder is a trained medical professional who reviews the patient documentation the provider creates in a patient’s medical record. From that documentation, the coder locates a code that best describes that patient’s encounter. They will assign a standardized ICD 10-CM diagnostic code and/or ICD 10-PCS codes and/or CPT codes that are found in current year code books, or computer programs called encoders.

16. Claim Submitted to Insurance Once a coder reviews the encounter and assigns the appropriate diagnosis and/or procedure codes the encounter is sent electronically to the payer Payment is expected within a specific time frame from the payer

17. Insurance Sends Payment Accounts Receivable processes payment Patient Accounts department (i.e. Billing) indicates payment was received in patient encounter. If an outstanding balance remains, patient accounts will send bill to patient

18. The Health Information Professional’s Role The HIP is a specially trained healthcare worker seen in a variety of non-clinical roles The HIP’s work is closely tied to the revenue cycle process from beginning to end The HIP partners with other departments in order to ensure a patient experiences both efficient and effective documentation processes before, during and after their encounter

19. Conclusion The patient revenue cycle is comprised of in a complex series of steps. Like well-oiled cogs in a machine, each step must operate efficiently within itself in order to ensure the entire revenue cycle is operational and sustainable. The Health Information Professional provides important information at each step, thus making the HIP a valuable asset in today’s ever-changing healthcare system.

20. American Health Information Management Association http://www.ahima.org/careers

21. References Davis, Nadinia A, Revenue Cycle Management Best Practices, AHIMA Press, 2011