Article | November 22, 2017

Four Ways To Address Data Management Challenges And Strengthen Your Revenue Cycle

Source: Health Language

By Beverly Holley, Health Language

pharmaceutical data management

Revenue cycle management can leverage systems and workflows that close gaps, tie up loose ends, and ensure submission of a clean claim. Reference data—representing the coded and uncoded data used across a health system—plays an all-important role in strategies that optimize revenue cycle processes and ensure compliance with industry licensing requirements.

As the market continues to shift to greater focus on value-based care and risk-based contracts, healthcare organizations must rely on massive amounts of claims data for analytics to optimize revenue lines. Reference data standards such as CPT®, CDT®, HCPCS, ICD-10, UB-04®, and other proprietary or custom codes sit at the core of these strategies.

Keeping this content up to date is an enormous challenge for the resource-strapped revenue cycle department as codes are added and changed over time, or become obsolete. Consider the annual CPT challenge—within the upcoming Jan. 1, 2018 CPT and HCPCS update, there are:

  • 191 code changes to CPT and HCPCS
  • Over 1240 term changes that can impact the meaning of the codes
  • An addition of two modifiers to existing codes

Healthcare organizations receive updates during the fall of each year and have until the first day of January to update their charge master by mapping the correct CPT to revenue cycle codes. This requires a manual analysis of all CPT changes to identify relevant changes, how those changes impact their revenue codes and business operations, and which pieces go into the charge master. These tedious, error-prone workflows often consume internal resources needed for other critical revenue cycle processes, or are outsourced to third parties to alleviate internal staff pressure—neither of which is an optimal solution.