Revenue Cycle Management

Milwaukee Regional Health System [Case 30]. This case illustrates the basics of revenue cycle management as well as the differences between charge master prices and the amounts actually billed and collected. The case considers both hospital and clinic (physician) settings. Although basic revenue cycle principles are relatively straight forward, successful management of the revenue cycle requires a detailed knowledge of the process, including the metrics used to benchmark revenue cycle functions. This case requires that you become involved with the some of the details, including metrics involved in revenue cycle management. (1a) using the template given in Exhibit 30.1, add one additional overall benchmark and one defect benchmark for each of the revenue cycle functions listed. (1b) describe each metric in the completed template and provide justification as to why these benchmarks were chosen over the alternatives listed in Exhibit 30.2. (2) Compare the benchmark values in your completed template with the actual MRHS metric values given in Exhibit 30.3. (3a) discuss your results. What actions might be implemented to improve revenue cycle performance? Complete the reimbursement amount template provided in the case for CPT 73722 (MRI of the knee) and DRG 470 (major joint replacement). Discuss the fairness and efficiency of the current fragmented reimbursement system to providers, insurers, patients, and society (the ultimate bearers of healthcare costs). (3b) assume that MRHS’s payer mix is 46 percent Medicare, 34 percent commercial/managed care, 16 percent Medicaid, and 4 percent self-pay/no insurance. (viii) Calculate the average expected payment for each of the two procedures (4) In a single paragraph, describe the revenue cycle and why good performance is so important to providers. (5) In your opinion, what are three key learning points from this case?

 

 

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