The ROI of Revenue Cycle and CDI Education
By Barbara Nelson Cullen
Revenue Cycle and Clinical Documentation Improvement Education
Accurate and efficient revenue cycle management (RCM) is crucial to a healthcare organization’s success. And because the revenue cycle is complex, detailed, and always shifting, staying on top of regulatory updates and latest best practices requires constant attention in this ever-changing industry.
By utilizing revenue cycle and clinical documentation improvement (CDI) education, organizations are thereby investing in their financial viability, their employees, and the patients they serve. In the case of revenue cycle education and CDI training, the impacts are beneficial to every aspect of the business — including those receiving care.
When employees are up to date on their education, healthcare organizations experience faster claim submissions, reduced denials, and more accurate reimbursements. These improvements lead to better patient care transitions and increased productivity and cashflow. The role of coding and training clinicians to document completely and accurately is paramount to a healthcare organization’s likelihood of success within the RCM process.
Importance of Coding to Revenue Cycle Management
Coding is arguably one of the most critical parts of the revenue cycle but is sometimes overlooked. Because coding occurs mid-cycle, it provides a unique opportunity to catch mistakes introduced earlier in the process, as well as then preventing similar errors in future.
Coding — and its completeness and accuracy — has a profound impact an organization’s bottom line. The art of coding is difficult enough. But when employee turnover or staffing challenges are considered, in addition to ongoing regulatory changes, the end results can make for a chaotic environment.
These challenges can easily lead to delays. When the coding process is stalled, the revenue cycle can be slowed by a backlog of charts, errors in claims, or working denials. The importance of coding to revenue cycle management cannot be overstated.
Benefits of Clinical Documentation Improvement
The benefits of clinical documentation improvement directly contribute to the overall health of an organization. With the growth in data availability and tracking, it is increasingly important for CDI education to become a priority for healthcare organizations.
CDI education stands to impact patient outcomes, data quality, and accurate and timely reimbursements. Without effective CDI, organizations are financially impacted, patient care is jeopardized, and employees must often do rework, potentially leading to frustration and burnout.
In one survey, 90% of hospitals reported an increase of at least $1.5M in healthcare revenue and claims reimbursement following CDI efforts. Additionally, 85% of hospitals experienced quality improvements and case mix index increases after implementing CDI education. Improved case mix indexes result in increased revenues and the best possible utilization of high value specialists.
Revenue Cycle ROI
A healthcare organization’s primary focus is delivering high-quality care to patients, which is difficult to accomplish if they’re not first and foremost operating in the black. This is what makes the importance of revenue cycle in healthcare paramount.
While staying out of the red is critical, showing revenue cycle return on investment (ROI) is the goal. With many moving parts and players, most organizations struggle with effectively capturing accurate ROI for revenue cycle management.
Ultimately, an organization’s revenue cycle ROI depends on the ability to reduce the cost to collect while increasing cash yield.
One approach is to start with education around the denials’ management process. In a survey by Dimensional Insight and HIMSS Analytics, denials were ranked as the biggest revenue cycle challenge (76.1%) among hospital decision-makers.
However, to truly maximize revenue cycle ROI, healthcare leaders should invest in education for all areas of the revenue cycle — not just what appears to be impacting the bottom line at face value. Improving each phase of the revenue cycle will have far-reaching benefits with long-term payoffs.
Revenue Cycle Education
Successful revenue cycle management doesn’t happen by accident. Healthcare leaders understand that clinicians can spend more time providing quality care to patients when every associate impacting the revenue cycle is informed and well educated on best practices. Revenue management cycle training modules are most beneficial when they’re easily available, accessible, and engaging.
Barbara is the Senior Product Manager at Relias. She has overseen Revenue Cycle and Coding education since 2008.