Optimize APC revenue with process-oriented assessments.

Abstract

To maintain or improve revenue streams under the Medicare outpatient prospective payment system (PPS), healthcare financial managers should use a process-oriented approach to assess the effectiveness of revenue capture in departments most affected by the PPS's use of ambulatory patient classifications, which typically include the radiology, cardiology, and emergency departments. Such an assessment should be conducted by a multidisciplinary team with senior management support. The team ideally should include the CFO, COO, and leaders from the departments to be assessed. Such an assessment process should consist of five basic phases: chargemaster/charge-capture analysis, revenue-capture process assessment, claims review, development of implementation strategies, and monitoring.