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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2021 Physician Network Healthcare Trends – Seven Insights to Guide Healthcare Organizations Through 2021
Per tradition, HSG has started the new year by reflecting on the healthcare trends, challenges, and opportunities we anticipate in 2021.
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ACHE – Physicians, New Year’s Resolutions and 2021
As we develop New Year’s Resolutions for 2021, now is the time to make resolutions related to priorities for your employed network.
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Employed Provider Networks and Health Systems May Suffer Under One Physician Executive Leader
HSG strongly encourages clients to consider two distinct physician executive leaders, over health system and employed provider network.