Lauralea Tanner, Chief Growth Officer at Acclara, describes the revenue cycle management critical decision points for hospitals, health systems, payers, and patients. In the hospital setting, there are lab tests, radiology, anesthesiology, surgeons, and other clinicians, all providing services that require proper coding and billing for collection. With many opportunities for errors and patient confusion, call center technology to handle questions, AI to address mundane coding tasks, and other technologies allow the professionals to take complex patient questions.
Lauralea explains, “So revenue cycle management really starts when the hospital or health system engages with the patient. So it starts with that patient intake process, or what we call patient registration or scheduling process, and then when they present at the hospital or the doctor’s office for services.”
“At that point, then it falls into clinical care. The patient is seen, and they’re treated. After the patient leaves, that is really where the hefty part of revenue cycle management kicks in. You have doctors that have to document charges. They have to dictate what they’ve done to treat the patient. They have to get all of that clinical documentation in place before it goes to coding, then to billing and collections.”
“A lot is still paper-based. The submission of claims, the follow-up, even the remittance advice that the hospital gets back from the payers is largely electronic. But you still have some of these smaller payers that do send paper, and it is very much a challenge to try to deal with that.”
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