Health Language Blog

Financial Stability in a Fluid Market

Posted on 11/01/17

Four Ways to Address Data Management Challenges and Strengthen Your Revenue Cycle

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Revenue cycle management can leverage systems and workflows that close gaps, tie up loose ends, and ensure submission of a clean claim. Reference data—representing the coded and uncoded data used across a health system—plays an all-important role in strategies that optimize revenue cycle processes and ensure compliance with industry licensing requirements.

As the market continues to shift to greater focus on value-based care and risk-based contracts, healthcare organizations must rely on massive amounts of claims data for analytics to optimize revenue lines. Reference data standards such as CPT®, CDT®, HCPCS, ICD-10, UB-04®, and other proprietary or custom codes sit at the core of these strategies.

Keeping this content up to date is an enormous challenge for the resource-strapped revenue cycle department as codes are added and changed over time, or become obsolete. Consider the annual CPT challenge—within the upcoming Jan. 1, 2018 CPT and HCPCS update, there are:

  • 191 code changes to CPT and HCPCS
  • Over 1240 term changes that can impact the meaning of the codes
  • An addition of two modifiers to existing codes

Healthcare organizations receive updates during the fall of each year and have until the first day of January to update their charge master by mapping the correct CPT to revenue cycle codes. This requires a manual analysis of all CPT changes to identify relevant changes, how those changes impact their revenue codes and business operations, and which pieces go into the charge master. These tedious, error-prone workflows often consume internal resources needed for other critical revenue cycle processes, or are outsourced to third parties to alleviate internal staff pressure—neither of which is an optimal solution.

Fortunately, there is a better way. Increasingly, hospitals and health systems are leveraging Health Language Revenue Cycle Solutions to establish centralized management of important revenue cycle content through a single source. Here are four ways our content offerings and services help meet the coding, compliance, and analytics needs of today’s revenue cycle teams:

1. Always Up to Date

The Health Language Content Update Streaming Portal coordinates with the world’s leading standards bodies to ensure our clients have the most up-to-date codes. Our data files create crosswalks between inpatient codes, ICD-10, and outpatient CPT for accurate data analytics and reporting.

2. Single Source of Truth

In addition to content, the Language Engine® provides the tools necessary to integrate all reference standards into enterprise data warehouses or third-party applications. This allows healthcare organizations to establish a single source of truth to support revenue cycle activity and enables revenue cycle teams to view, manage, export, and standardize all reference data on a single platform.

3. Compliant with Licensing Requirements

Many standards bodies have a licensing requirement that must be met to use their content, and it’s not uncommon for healthcare organizations to be unaware of whether they are meeting these expectations. Because standards bodies are increasingly cracking down on licensing compliance, it is important that healthcare organizations have a licensing strategy in place. As a licensed distributor for CPT, CDT, UB-04, and many other standardized code sets, Health Language takes the guesswork out of these processes, making it easier to stay compliant with the leading standards bodies.

4. Ongoing Change Management

While the Health Language Content Update Streaming Portal and the Language Engine provide needed data management infrastructure, healthcare organizations must still manage content changes on an ongoing basis. For instance, a revenue cycle director needs to understand how annual CPT changes impact business operations by identifying what is relevant and what is not. Instead of manually analyzing hundreds of updates, the Health Language services team can help narrow the playing field for efficient, effective change management. Our staff of AHIMA-approved ICD-10 trainers and certified coders, medical professionals, PhDs, and medical informaticists review and publish all of our updates and are available to provide expertise for a wide range of data management projects.

The changing paradigm of healthcare reimbursement demands that healthcare organizations have efficient, effective revenue cycle practices for future positioning. Today’s hospitals and health systems need the full suite of Health Language Revenue Cycle Solutions to optimize ongoing management of critical reference data and remain confident that revenue cycle is up to date and compliant.

Topics: revenue cycle management

About the Author

Beverly Holley has 14 years of medical industry experience working with both providers and payers. She is a Certified Professional coder through the American Academy of Professional Coders (AAPC) and a certified ICD-10 Trainer through the American Health Information Management Association (AHIMA). Additionally, Beverly recently completed an American Medical Informatics Association (AMIA) course in Bioinformatics where she prepared a paper on the use of Value Sets. Beverly joined the Health Language team in 2013 and currently leads a team of professionals that are a vital part of our content consulting team. In that role, she oversees the professional services clinical implementation activities. She and her team help our clients map their data to standardized terminologies, create and maintain solid data governance practices, remediate for ICD-10 and provide consulting services for our 280+ content sets.