Unique Strategies Today’s Top Medical Organizations Use to Maximize Revenue

Robert West
Published: February 25, 2020

They Get E/M Coding Right

The evaluation and management (E/M) patient visit is a crucial part of any healthcare organization.

Good healthcare organizations can maximize revenue by understanding how to properly document and code E/M patient visits.

Proper documentation and coding does more than just boost revenue; it also reduces the stress of audits and boosts the efficiency of staff.
A July 2019 article published in Medical Economics highlighted four ways healthcare organizations can boost revenue by getting E/M coding right, including:
Ensure the E/M code supports the specific patient encounter. Not every patient with asthma, for example, will justify reporting CPT code 99213.
Refer to E/M guidelines when assigning codes. Assigning E/M codes is not a subjective process. Many physicians under-document E/M level 4 and 5 visits for new patients, for example. Follow E/M guidelines for coding and billing.
Use copy and paste functionality carefully. Some healthcare organizations get into trouble by over-utilizing the copy and paste functions. A physician who automatically copies and pastes historical information from a previous encounter into a current note, for example, may accidently inflate the E/M level.
Be cautious with pre-populated EHR templates. Pre-populated templates can lead to upcoding – say, when certain body systems are always indicated as having been reviewed even when they’re not relevant to the current encounter. These templates can also lead to contradictions that lead to red flags with payers – say, if a physician diagnoses a patient with strep throat and uses a default ear, nose, and throat exam template, opening the door for a post-payment audit.
Implement better E/M coding practices into your healthcare organization to boost revenue.

They Optimize Charge Capture Services with Artificial Intelligence

A recent study showed most healthcare executives believe charge capture is essential, yet 40% discuss it just once a month or less and only 8% discuss it daily.
Charge capture is obviously critical for revenue generation within healthcare organizations.
That’s why some leading healthcare organizations have started using unique strategies to optimize charge capture services: they’ve started to implement artificial intelligence.
AI-powered charge capture services are helping to boost staff efficiency for providers while also encouraging greater self-sufficiency for consumers.
It’s part of a widespread trend of healthcare organizations using AI to enhance revenue. Today, AI is helping companies revamp everything from registration to scheduling to billing.
Artificial intelligence automates significant parts of the charge capture service cycle, freeing staff from tasks that are important – but also time-consuming and redundant. Thanks to the latest AI technology, organizations have reduced labor costs and recovered leaked revenue while focusing on both high-dollar and low-dollar accounts.

They Comprehensively Maintain the Chargemaster to Prevent Revenue Leakage

The hospital chargemaster is the heart of a hospital’s revenue generation. That’s why it’s so surprising to see some healthcare organizations fail to adequately maintain their chargemaster.
Inadequate or poorly-maintained chargemasters can lead to overpayments and underpayments, claims rejections, and compliance violations, among other issues.
Chargemaster maintenance is a continuous process that ensures all services are accurately charged. Good maintenance involves reviewing and updating the chargemaster to ensure the hospital is compliant with government pricing regulations, for example, and ensuring the organization receives accurate reimbursement.
As public and private payers continuously update or change coding and reimbursement rules, chargemaster maintenance can become particularly challenging. Smart healthcare organizations, however, solve these challenges to optimize revenue.

They Confirm Compliance with CMS and Regulations

Poor compliance can quickly lead to poor revenue. Smart organizations confirm compliance regularly to ensure revenue flow remains strong.
One of the best ways to confirm compliance is to conduct a code review.
HMI Corp specializes in code reviews for inpatients, outpatients, and E/M coding to ensure compliance. We can comprehensively review your organization for compliance issues, then explain exactly what needs to be changed to optimize revenue.

Final Word

One of the best ways to maximize revenue, of course, is to minimize costs. Medical organizations can minimize costs in all different ways.
Discover how your healthcare organization can minimize costs and maximize revenue. Schedule a consultation with HMI Corp today. We have proven expertise offering healthcare revenue cycle management consulting services and chargemaster reviews among other revenue-boosting services.

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