Unified Reimbursement Strategy: Implementing Common Ground Among Next-Generation Reimbursement And Quality Systems

By John Glatthorn, Written for Elsevier Revenue Cycle eLearning Solutions

We may look back on the 25-year span following the change of the millennium as one of the most densely populated periods of healthcare regulation ever seen in the history of the United States. Every year, individual clinicians, private practices, and health systems are bombarded with new coding, compliance, quality, and reimbursement models, making staying ahead of the curve in terms of overall strategy nearly impossible. Executives, physicians, and healthcare experts would probably agree that it is impossible to maintain a status quo level of performance if your strategy is one of pure reaction to each new deadline from the Department of Health and Human Services.

Although we all agree that this is not an ideal way to approach the onslaught of rules and penalties that will inevitably change our healthcare business forever, this siloed and reactive thought process is by far the most commonly implemented strategy (or lack of one) in the marketplace today. For many institutions, ICD-10 was the first significant foray into a highly structured, project management-oriented transition plan that encompassed almost all the healthcare provider and administrative disciplines into one unified approach. Enterprise EHR implementations have done this for the information technology and clinical worlds but one might argue that these projects rarely included HIM, revenue/reimbursement, and CDI professionals as equals or even key players.