Leveraging Hospital Inpatient Clinical Revenue Cycle Management to Prevent Revenue Issues

Effective inpatient clinical revenue cycle management (RCM) is crucial for hospitals aiming to maintain financial health and operational efficiency. Key components such as Utilization Review (UR), Clinical Documentation Integrity (CDI), and inpatient coding play pivotal roles in ensuring accurate billing, reducing denials, and capturing earned revenue.

Revenue leakages in the context of the hospital inpatient clinical revenue cycle management refer to financial losses that occur due to inefficiencies and errors within the revenue cycle. These leakages often arise from departmental silos where communication breakdowns lead to discrepancies in patient documentation and billing. Consequences include denied claims, underpayments, and increased administrative costs, all of which strain hospital finances and disrupt inpatient operations. Early identification and resolution of these issues through a robust appeals process are essential to minimizing financial losses and ensuring the hospital’s revenue integrity. Further, preventing denials before they occur is ideal by optimizing utilization review processes and CDI processes streamlining the physician advisor review process and educating admitting providers how to document to support the medical necessity and acuity of inpatient admissions.

1. Patient Status Errors: Misclassification of patient status, such as incorrect assignment to inpatient or observation services, can result in significant revenue loss.
2. Inadequate Clinical Documentation: Lack of thorough and accurate clinical documentation impedes proper coding and billing, leading to claim denials and delayed reimbursements.
3. MS-DRG Coding and Sequencing Errors: Errors in MS-DRG (Medicare Severity Diagnosis Related Group) coding or sequencing can affect reimbursement rates and increase the likelihood of audits and denials.

Utilizing revenue cycle analytics can help identify trends and patterns contributing to revenue loss, allowing hospitals to address these issues proactively.

1. Effective Utilization Review (UR): Ensuring appropriate and timely patient status assignment is critical. UR staff should be well-trained to evaluate the accuracy of the ordered patient status based on clinical criteria and payor guidelines.
2. Physician-Led DRG Validation: Engaging physician advisors in the DRG validation process helps ensure coding accuracy, reduces denials, and enhances overall compliance. Our physician advisors’ clinical expertise combined with coding knowledge leads to more precise and defensible claims.

Brundage Group offers specialized services designed to enhance hospital inpatient revenue cycle management:

1. Revenue Cycle Analytics: Our analytics services provide data-driven insights that identify revenue leakage trends and patterns, allowing hospitals to make informed decisions and implement effective corrective actions.
2. Physician-Led DRG Validation: Our team of experienced physicians and coders work collaboratively to validate DRG assignments, ensuring accuracy and compliance. This approach helps reduce denials, capture earned revenue, and improve overall financial performance.

By focusing on effective inpatient clinical revenue cycle management, hospitals can minimize revenue leakage and enhance financial stability. With the support of Brundage Group’s comprehensive services, healthcare systems can achieve greater accuracy in coding, improve patient status assignment, and secure the revenue they deserve.

Ready to capture earned revenue and enhance your hospital’s financial stability? Contact Brundage Group today to learn how our expert services in revenue cycle analytics and physician-led DRG validation can help your facility achieve optimal revenue cycle management.