Paying adequate attention to and investing in a professional service coding program is crucial for employed network sustainability. An effective program directly supports patient care revenue generation, provider productivity determinations, and corporate compliance assurance. While technical services coding and billing are also important facets of the network revenue cycle – especially in provider-based billing scenarios, many networks experience greater inadequacies in the professional services elements as these differ significantly from other hospital billing practices.
Programs that offer one-time or episodic general provider education tend to be relatively ineffective as the information often does not “stick” with the providers – especially if the session(s) are perceived to lack direct applicability to an individual provider’s circumstances. It is also difficult to provide a “one size fits all” educational session – even by specialty – as circumstances vary so significantly within and across specialties.
Effective programs tend to combine regularly performed audits with timely individual educational feedback about each audited patient encounter – while reviewing the encounter documentation and providing direct insight. This approach tends to make the interaction more “real” and to produce more enduring results.
HSG partners with health systems to:
HSGs process for Ambulatory Revenue Cycle Assessment combines data-driven assessment of a health system’s revenue cycle performance combined with on-site observation and evaluation of revenue cycle processes to quickly help leadership identify opportunities for improvement, size those opportunities from a potential revenue gain perspective, and prioritize effort going forward. Once specific opportunities are identified, HSG and our client health systems work to determine what elements can be driven by internal resources, and which, if any, need implementation assistance from HSG. This includes ongoing ad-hoc advisory basis, addressing specific initiatives on a project-by-project basis, or providing interim leadership over specific functions as process improvement opportunities are implemented, before transitioning them back to client leadership.
Related Resources
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MGMA Connection Magazine (Employed Network Transformation and Patient Share of Care)
MGMA Connection Magazine – July 2021 Leadership Issue (HSG Articles: Transforming Your Employed Provider Network and Patient Share of Care)
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Healthcare Consulting Thought Leadership (OHA 2021 Presentations)
HSG presented four healthcare consulting educational sessions on key areas related to employed provider networks at OHA’s 2021 conference.
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Physician Network Transformation – Transforming Mon Health Medical Group (ACHE)
Mon Health Medical Group Physician Network Transformation. From misaligned group of practices to high-performing multispecialty group.
