Four solutions to healthcare revenue losses


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This presentation demonstrates four ways in which a healthcare organization can reduce the loss of their revenue and increase their bottom line.

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Four solutions to healthcare revenue losses

  1. 1. By: Cynthia Brown, MBA, RHIT, CCS Owner CyntCoding Health Information Services
  2. 2.  Form an in-house Ethics Committee with key personnel as members.  There should be an ethics officer in place who has an open door policy and who is a member of the committee.
  3. 3. The role of an ethics committee was solidified in 1992 when the JCAHO mandated healthcare organizations to develop ways to address ethical issues in their facilities (AMA, 2008). Therefore, if for no other reason than it will be an essential requirement of JCAHO accreditation, your organization would benefit greatly from the development, implementation, and monitoring of an in-house ethics committee. An effective ethics committee can oversee matters involving the false filing of claims, misleading coding, and other financial issues of reimbursement to the facility.
  4. 4.  Employee Relations is essential to maintain a positive and productive work environment.  An Employee Relations Manager should be included as one of the positions in the HR department.
  5. 5.  An Employee Relations Manager (ERM) would ensure that there is regular feedback between staff and management; which would include performance evaluations and rate of pay evaluations.   A period salary comparison should be made by the ERM to ensure job rates meet the industry standards. An ERM working along with a HR director, management, employees, and other key personnel can help to foresee, advise, and resolve employee conflicts with management.
  6. 6. “Employee Relations involve the body of work concerned with maintaining employer-employee relationships which contribute to satisfactory productivity, motivation, and morale (NASA, 2009).” Essentially, Employee Relations is concerned with preventing and solving problems involving individuals which arise out of or affect work situations (NASA, 2009). Along with providing a means of evaluating employee performances, employee relations can be a mechanism for solving employees issues, such as pay increases and other grievances before they arise.
  7. 7. Medical Necessity Guidelines should be developed and implemented with a plan in place that ensures checks and balances for “best practices” and “medical necessity” for each inpatient and outpatient stay or visit to the facility.
  8. 8. Medical necessity is “healthcare services that a Physician, exercising prudent clinical judgment, would provide to a patient for the purpose of evaluating, diagnosing or treating an illness, injury, disease or its symptoms (CIGNA, 2011).”
  9. 9. The seriousness of fines, loss of reputation, and loss of revenue through accrediting agencies should be enough justification to develop, implement, and monitor Medical Necessity Guidelines. Medical Necessity Guidelines can help to eliminate unnecessary medical care whether intentional or unintentional. It helps the facility meet its “best practices” doctrine, because it makes the provider look at the type of care they provide. Of course, what is deemed necessary must meet other standards set forth by third party payors and legislation.
  10. 10. The Company should not just have a “Code of Ethics” in place it should ensure that each employee no matter their position knows what it entails and how to respond when it is not being adhered to.
  11. 11. The facility should instigate community involvement demonstrating the company’s intentions to regain trust and move forward with a sincere desire to operate ethically.
  12. 12. The violators of any of the legal issues adopted by the facility should be prosecuted and the community and investors alike should be made aware that unethical behavior at the facility has a zero tolerance.
  13. 13. The Company should also demonstrate its strategic plans to improve in the services provided through quality assurance, performance evaluations, and peer review.
  14. 14. Lastly, a Public Relations expert should be consulted.
  15. 15. When a company is publicly traded it has a responsibility to its shareholders to operate in a manner that does not put the dollars invested at risk. Unethical behavior is definitely a threat to shareholders’ investment. There are also other major stakeholders who stand to lose when a company is no longer soluble (i.e., employees, suppliers, patients, and the community as a whole). The loss in employment and the revenue dollars generated by the business is irreplaceable. The opportunity for education for the physician and healthcare providers is invaluable. The void as a result of a facility’s demise can be potentially crippling to communities and the economy of the nation.
  16. 16.  Cynthia Brown, MBA, RHIT, CCS  AHIMA approved ICD-10 CM/PCS Trainer  CyntCoding Health Information Services  Phone: 404-992-8984/E-Fax: 678-805-4919  P.O. Box 3019  Decatur, GA 30031 or  
  17. 17. O’Reilly, K. (2008). Willing, but waiting: Hospitals ethics committee. Retrieved December 13, 2013 from http:/ NASA. (2009). Employee relations: What is employee relations? Retrieved December 13, 2013 from http:/ hatis.htm. CIGNA. (2011). CIGNA Healthcare definition of medical necessity for physicians. Retrieved December 13, 2013 from http:/ procedural/medical_necessity.html.