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In the value-based care reimbursement landscape with several regulations and reforms, hospitals and practices are looking for new ways to keep their bottom line strong. Medical billing and coding outsourcing helps to a great extent by helping providers stay ahead to these changes and optimize claim submission and revenue. According to a recent article in Revenue Intelligence, care standardization can be an important revenue strategy. The report describes how St. Luke’s Health System, one of 15 top health systems in 2017, achieved financial improvements by reducing care variations.

Care Standardization as a Key Revenue StrategyThere are many reasons for practice variation such as an increasingly complex healthcare environment, the challenge of maintaining current medical knowledge which is increasing at a fast rate, and excessive reliance on subjective judgment.

Care standardization is a controversial subject. Those who oppose it say that standardizing will take the personal element out of the physician-patient relationship and that it amounts to dictating patient care and management to physicians. However, a document published by The American College of Obstetricians and Gynecologists on standardization of practice to improve outcomes points out that clinical variations in process improvement are recognized when it is “dictated by, among others, differences such as a patient’s age, ethnicity, weight, medical history, and desired outcomes of therapy” or other unexplained variation not related to these factors. The report says that performing critical processes the same way every time can reduce the types of errors that patients are exposed to. On the other hand, the ACOG also recognizes that in the case of some patients, care cannot be managed by standardized protocols because of clinically valid reasons. In such situations, the physician should clearly indicate in the medical record why the protocol or checklist is not being followed and explain the rationale for divergence from the recommended practice.

Clinical standardization is beneficial and can prevent errors if it can improve supplies management, patient appointment scheduling, and the lab testing follow-up process. Now, the experience of a top provider like St. Luke’s shows that it can boost revenue cycle management (RCM). By standardizing their processes and performing consistently, the hospital system improved quality care measures which increase costs without adding value such as long emergency department wait times, in-hospital deaths, complications, and longer length of stay. The benefits that the healthcare system experienced through standardization of care include:

  • Better tracking and improvement of costly healthcare events for patients with high-risk conditions, such as sepsis, heart failure, stroke, and pneumonia
  • Reduction in variations of care and costs by tracking and measuring lengths of stay, readmissions, complications, and other factors that contribute to excessive costs
  • Improvements in blood transfusions management which led to savings of nearly $2 million over the years as well as decreased infection rates

Care Standardization as a Key Revenue StrategySt. Luke’s Health System’s success can be attributed to its team approach in implementing value-added quality improvement projects across its network. Clinicians, staff members, administrators and executive-level leaders were involved in the process. RCM and quality care goals are central to hospital workflow and every department is required to report on issues they face as well as their performance.

A recent REMITdata survey of healthcare providers, medical billing companies, and vendors showed that the key concern was maintaining profitability while staying independent. Today, RCM has taken a new turn with the value-based reimbursement models. Managing this key process effectively and staying financially relevant is crucial to be able to provide quality patient care. This is where medical billing and coding services comes in.

Only an experienced billing service provider can help hospitals and practices manage the administrative and clinical functions associated with claims processing, payment, and revenue generation. They can efficiently carry through the entire process starting with patient eligibility verification, scheduling and registration and claims submission to collection of revenue and management of denials. In fact, a medical billing and coding company helps physicians standardize documentation and care to meet payer guidelines with accurate CPT and ICD coding. Standardizing these processes is an important step in standardizing patient care across the healthcare system.