As the Lean Enterprise Institute abbreviates the categories of the lean method for quality improvement, lean consists of 3 major components: Process, People, and Purpose. These components delineate further into value, capability, availability, adequacy, and flexibility in the flow of claims production from the provision of services.
RCM consists of scheduling, arrivals, front desk operations, billing & coding, claims processing, claims transmission, collections, and account reconciliation.
In graphic and educational examples of the revenue cycle; appeals of denials and rejections are included as a step in revenue cycle management. Lean management contradicts this step by looking at appeals for claim denials and rejections as an exception, not a rule. Lean strategies expect that errors causing claim denials and rejections are avoided, not accepted as a routine process.
Through a case study(s) example, the webinar correlates the lean process through the revenue cycle to dispel misleading and narrow assumptions of revenue shortfalls (our contracts do not provide enough reimbursement) to the subset of issues that lead to root cause analysis and actions to monitor the progress of solving the subset of problems.
While the concepts of lean and RCM is not new to experienced revenue managers and staff, re-enforcement through original case studies in the current environment take the attendee through original experiences that generate critical and authentic consideration of processes for quality improvement and increased revenues. This is notably important in an environment of cost pressures from government policies and insurance pressures.
Introduction of case study
Identification of factors in case study that raise questions about root causes of revenue shortfall
Application of lean strategies to identify root causes
Application of staff team specialists to analyze root causes
Identification of root cause solutions by priority
Application of responsibility and accountability
Application of reporting schedule and analysis
Application of process to change original plan
Reporting of return on investment
Correlation of lean processes to RCM
Job roles that can benefit from this webinar include, but are not limited to:
Staff related to Revenue Cycle Management
Dr. Steven M Wagner
Executive Director and Faculty Instructor at the Paul L Foster School of Medicine at Texas Tech University Health Sciences Center @ El Paso
Faulty Instructor at Independence University in Department of Health Sciences for Health Care Administration, Health Information Management, and Public Health
Research Fellow at University of Phoenix
40 years experience in revenue cycle management for hospitals (public and private), academic medical centers, and physician practices
Book author for Health Insurance and Health Outcomes: How Does Health Insurance Change Patient Health Behavior, and many other journal and peer reviewed publications
Can’t attend the live session? Register to receive complimentary copy of recorded webinar