What Is A Revenue Cycle Consultant?

In February I gave a talk to students at Syracuse University that was hosted by one of their sororities titled "Health Care Diversity And It's Affects On The Minority Community". Although that talk went very well and was well received, the funny thing was that's not the original presentation I put together for it.

Jason Armstrong via Compfight

When I was initially contacted, I was asked to put together a presentation on what a revenue cycle consultant does. I created that presentation, set it up so that it could be as long as 2 hours, then worked on whittling it down to around 30 minutes. That's how I work on speaking projects; I always put together a long outline, rehearse, then start cutting what's not really needed or adding more if I'm supposed to talk longer.

Anyway, I had this pretty good presentation that I put together that I didn't get to do. I also realized that in all the years I've had this blog I've never addressed that specific topic; talk about a bad business move, especially since I always tell people that's what I do (unless I'm not talking to people in health care, because... they don't care).

Back in December I wrote a two part series on the basics of being a CDM consultant, but I talked almost exclusively about charge master consulting rather than revenue cycle consulting as a general topic. However, I used my best opening line when talking about charge masters in that article... and I was slightly wrong; let me explain.

In that article I said that the charge master was the respiratory system of a hospital, physician, clinic... any medical entity that needed a quick way to capture charges that are already priced and coded so bills can go out quicker. Only, it's kind of a misstatement.

Truth be told, revenue cycle is actually the respiratory system of medical providers, with the circulatory system being the most critical as it includes doctors, nurses and other clinical providers. The charge master is actually the respiratory system of revenue cycle; whew, glad I fixed that.

Back to the original question; what is a revenue cycle consultant? To answer that, I now have to tell you what the revenue cycle consists of:

1. Admissions/Registration

Anyone who's ever been anywhere to get medical services has had to give information to someone before they can be seen. These are the front end people, and what they do is critical because if they get all the information up front correct it can help speed up the billing process if everything else along the line is done properly. Admissions is usually the term used for inpatients, while registration is for everyone else.

2. Charge Capture/Ancillary Departments

Ancillary departments are those that generate revenue such as radiology and lab. Pharmacy is technically an ancillary department while supply isn't, since they supply the ancillary departments with those supplies. The charge master is most crucial to this stage of the process because the people capturing the charges rely on it being correct and set up properly throughout the computer system.

3. Billing/Patient Accounting/Business Office

Everyone knows what this is... at least they think they do. These days, there's very little billing done in the billing department because most claims go out electronically and, unless there are major errors, probably 95% of medical claims are never seen by anyone in billing... or any of the names you see above. Once again, the charge master is crucial here because of the pricing and specific codes that have to go on the electronic claims in order to get paid.

4. Collections

Luckily most patients don't have to deal with these folks, who in my opinion have the hardest job in the entire process. They're the ones who have to chase people down after they've gone back home and try to get payment or payment arrangements from them. This is while patients either feel better or worse from their medical experience and had moved on from remembering that they might owe any money to anyone, either those who treated them or performed some kind of procedure on them.

Now that you know what the revenue cycle is, you pretty much know the duties of a revenue cycle consultant. The best consultants know every piece of the revenue cycle process, with the possible exception of charge master. I've found few revenue cycle consultants who have a good understanding of the process or coding; that one thing helps to set me apart from the majority.

What we do is either fix or help improve these systems and processes when there are issues. For instance, if admissions/registration has problems with accuracy or speed in getting people into the system, a revenue cycle consultant can address that.

If charge capture is an issue, same thing.

If accounts receivables start to climb and cash is falling, or there are a very high number of denials, having someone on the outside come in to help can be very beneficial.

Collections is all about process and identifying the best claims to work on, and sometimes an outsider with a lot of experience in dealing with such things can bring new ideas to help rectify the situation.

Over the next few months, I'll be integrating more articles about this process into my articles here, along with my normal leadership, diversity and motivational items. After all, what I've just noted here is only a small section of the presentation I put together. Who knows, maybe these articles will help someone that needs it, like when I wrote my article giving 10 revenue cycle tips last November.

Or maybe it'll just help me; I have no shame. 🙂