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Epic revenue cycle consulting with post implementation workflow analysis is critical to assuring that what was “built” in the “system” is working well. During a recent engagement at an academic medical center, Health Systems Management Network, Inc. (HSMN) revealed the hospital experienced revenue loss and a higher rate of denials pre and post claims submission. The system as built by the hospital staff turned out not to reflect the reality of needed workflows and the creation of work arounds and redoing of work.

HSMN has learned that MEDPAC (The Medicare Payment Advisory Commission) is set to reduce hospital payments for ambulatory/outpatient procedures to the rates paid in a physicians’ office.

HSMN announces the formation of a “Financial Structural Assessment Team” under its Organizational Structure division. The purpose of this Team is to assess the financial structure within the revenue cycle management and determine how roles should be defined, work processes refined, system efficacy, staff allocation by function and finally the leadership.

Recent studies based on current client data show that the revenue cycle of some hospitals are projected to see an impact of a negative 2-3% on net revenue with the implementation of ICD-10-PCS Coding. HSMN in working with its client base has found that clients are counting on tools and systems rather than experience, training, Medical staff behaviors and critical thinking skills.

Many of HSMN’s clients thought that they could rely on the Encoder to crosswalk ICD-9-CM procedure codes to ICD-10-PCS. The newsflash is that the Encoder, no matter which product is used, cannot convert the ICD-9-CM procedure code to the ICD-10-PCS. HSMN has just announced that its Start Team (ICD-10) will assist hospitals and physician practice management with complex procedure coding under ICD-10-PCS.

Health Systems Management Network, Inc. (HSMN) in its 27 years of operation has often found that both hospitals and large medical practices, especially faculty practices, have found that sometimes the installation of new systems has changed their revenue outcomes. They ask the questions: Why is the AR climbing? Why are we realizing fewer dollars from our patient encounters? These revenue cycle management questions challenge every physician practice, hospital and specialty practice groups in the industry.

Health Systems Management Network, Inc. announces an expansion of its START Program, the program designed to assess the state of readiness for ICD-10-CM medical billing and procedure coding. The expansion has been implemented to support providers who want to know how they will do with their payors once ICD-10-CM is in effect. The expansion includes all payors regardless of where the facility is.

In their February Newsletter AIS Health Confirms from a recent Study what HSMN had announced recently: Payoffs for smaller MSSP groups with tiny savings are unlikely. In its previous Press Release in which HSMN announced the implementation of its ARP Teams HSMN also indicated strongly that without the proper assessments neither clinical practice nor any organization can know how they will end up financially. HSMN is now underway advising Physician Practices and Hospital clients who have asked HSMN to help them decide (as a group or individual practitioner) to join an ACO or create one by acquiring medical practices. Some Physicians are investing with others in trying to acquire the expert knowledge to get them ready to become an ACO (Accountable Care Organization under the Affordable Care Act). HSMN’s ARP Teams of Healthcare Financial Management Operations/Financial Strategists are looking at many practice and hospital system situations to determine whether such a dramatic step is warranted. The simple question of “Where have we been?” and “Where are we going?” (in practice) must be answered by both the Hospitals and Physicians.

HSMN recently announced a new Physician Practice Management Reimbursement Readiness Program or PPMRRP in which it would provide Physician Groups with an internal capability to demonstrate outcomes of their practice of Medicine. It is important that Medical Practices begin a transition that allows them to track outcomes. The first order of business is to review cases done by all of the partners or associates in the Practice and establish a standard for every procedure and diagnoses.

HSMN is proud to announce the extension of its Resource Revenue Opportunity Program (RROP) as part of its Hospital Billing Group. In July of 2010 one of HSMN’s Academic Medical Center clients asked whether they had really exhausted all of its avenues to Revenue Improvement. The answer was to look at all of their data on patient encounters and procedures to determine what if anything had been missed.