One of the best ways for a hospital to bring in more revenue is to have a clinician review procedures for missed charges. Yet revenue cycle teams often push back on this approach. When that happens, they aren’t being obstinate for no reason; they likely believe they have everything well in hand. To address this, you need to understand their thinking. So here are the top three reasons your staff may resist this way of helping you increase hospital revenue.

1) They believe they are already charging for every legitimate procedure. (But they aren’t.)

The more experience your rev cycle team has, the more likely they are to believe they are already charging for every possible procedure. They may say they have been “doing this for years” and insist they are on top of it. They may feel that it would have been mentioned by now if a charge was being missed.

Your team may tell you they already have someone reviewing the charges. But 99% of the time, that person has no clinical experience. And without that clinical knowledge, they have no way of knowing what aspects of a procedure are not being included in the charges. 

Your team may also think that, if a procedure is missed, it’s because it is not legal or ethical to charge for it. Yet they may not understand what that charge is or why a payer would not object to paying it.

In these cases, a little education goes a long way towards getting staff support for further investigation. Once your rev cycle team understands how charges can slip through the cracks without a clinical perspective to catch them, they will likely get on board. And the same holds true if they think a procedure may not be appropriate to charge for. Once they understand the details, they will usually support the new approach.

2) They are concerned it will make them look bad. (But it won’t.)

In some cases, a rev cycle team accepts that a clinician will be able to find charges they missed. However, instead of thinking of this as a way to bolster the hospital’s bottom line, they get concerned about their own standing. Given the highly competitive nature of the healthcare industry, this is not a surprise. Yet it has to be addressed if the hospital wants to increase its revenue.

In truth, no one expects members of the rev cycle team to be clinicians. That is why a clinical skill set has to be brought in as a supplement. To help your team see this, it is good to remind them that they are meeting all expectations. Everyone accepts change easier when they are appreciated for the work they have been doing, and even more when they can envision a role for themselves after the changes are made. In this case, your team can help you rebill the charges and ensure they are charged for in the future.

3) They are worried they don’t have enough time. (But they won’t need it.)

Another obstacle can be the simple lack of time facing your rev cycle team. They are likely already maxed out and cannot imagine adding the task of overhauling their charges to their already full plate. 

This concern is easy to assuage – after all, bringing in an outside team to share their clinical perspective will actually take pressure off them. The outside team will take on the burden of doing the review and handling the re-billing. While your IT team is going to have to gather the data files, your rev cycle team will only need to set up any missing charges and post the payments. That will likely require far less time than they fear.

It’s important to include your rev cycle team from the start.

Once your rev cycle team realizes that there is revenue to be gained by bringing in a clinical perspective, they will usually get on board. If they don’t, they may believe they are already handling it, or that they will lose face, or that they simply don’t have enough time. By addressing those concerns, you can support your team while bringing in the revenue your hospital needs.

Photo by Wolfgang Rottmann on Unsplash

Missed Opportunities

The Hospital CEO and CFO Guide to Recovering OR and ER Charges

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