Thursday, June 9, 2011

Walking In the Shoes of the Revenue Cycle Team

Recently, I had the pleasure of walking in the shoes of another great GRMC department, the revenue cycle team. This department includes admitting, coding, and patient accounting. A "walk in the shoes" is like a job shadowing experience and I learn new things about the various functions that employees do everyday to make this hospital run smoothly.

What a very busy and complex world the revenue cycle team lives in each day!

Let's walk through it from a patient's perspective:
It all begins with a physician order for the patient to get care from the hospital. When the patient arrives, they are greeted by our resource nurse and/or our volunteer. If they need their car parked or have a question with the order, the resource nurse is there to help. The volunteer helps organize the patient's trip through the process and often escorts them exactly where they need to go.

The admitting clerk goes through a very detailed process of making sure we have all the necessary information so the patient receives the care or service they came to the hospital for and so the hospital can appropriately bill for those services.

The patient receives an identification wristband and then they move on for testing, a procedure, treatment, or whatever brings them to GRMC that day.

What happens behind the scene is vitally important for the patient, even though they may never meet these staff members. After the service is provided to the patient, a record is established and sent to the coding team. Their job is to convert the record of the care the patient received into one of what seems like a zillion codes to be submitted on a bill to Medicare, Medicaid, or a private insurance company. This is very detailed work.

The coded description of the care the patient received at the hospital is sent to our staff members who create and submit the bill to the insurance company, Medicare, or Medicaid for payment.

When the hospital receives payment from the insurance company or from Medicare or Medicaid, it is time to create and submit a bill to the patient if needed. At GRMC, we have outsourced this activity to a third-party billing company and information is submitted to them to create a bill for the patient.

We also have cashiers who interact with patients directly that might not have insurance. The cashiers receive payments or help patients set up a payment plan.

Bottom line: these employees have challenging jobs because the details frequently change and the work can be very complicated. I was impressed with the cross training that employees have and the team environment that has been created. They work hard to balance great customer service with the need to be sure we are safeguarding the financial health of the medical center.

Also located in this area is the hospital operator. That is another job that can be really hectic at times with the number and variety of calls that come to GRMC.

Everyone on this team is dedicated to great patient care and to the mission of GRMC. Thanks for all you do!

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