Managing And Improving Revenue Cycle Management Dr. Shairein Ahmed Head of Revenue Cycle Management Healthpoint Hospital
Managing And Improving Revenue Cycle Management
Dr. Shairein AhmedHead of Revenue Cycle
ManagementHealthpoint Hospital
Revenue Management Life Cycle
FRONT -END
• Payer negotiation and renegotiation , patient accesses including scheduling , preauthorization , insurance verification , Point-of-service collection and financial counseling.
MIDDLE • Clinical documentation, Change capture, coding, case management .
BACK-END• Claims processing and payment posting , Follow-up, customer service,
collections and denial management .
MEDICAL DOCUMENTATION
PROPER CLAIM PROCESS
FAIR REIMBURSEMENT
Digital Documentation Improvement
The quality of data generated is Increasingly tied to cost efficiency under value-based reimbursement models
Clinical Documentation
• OP: Evaluation and Management Levels Fair reimbursement would be maintained through insuring the correct level of care
• IP: Case Mix Index The CMI of a hospital reflects the diversity, and clinical complexity of IP patients in the hospital.
Thank you!
Dr. Shairein AhmedHead of Revenue Cycle
ManagementHealthpoint Hospital