Just One Uneducated Revenue Cycle Staffer Could Cost You $367K
Staff Competency Has a Direct Impact on Financial Performance
Coders, CDI Specialists, Case Managers, and others that support the Middle Revenue Cycle, have the challenge of mastering a sea of regulatory and compliance rules in order to properly manage a patient’s care and ensure an accurate patient record translates to appropriate reimbursement.
To illustrate this dynamic, below is an example of Medical Necessity Denials related to MRI of the brain (with or without contrast).
MRI Cost (requires prior authorization) = $1,019
Number of MRIs performed monthly = 300
Number of MRIs denied due to lack of prior authorization = 30 (or 10%)
Unfortunately, corrective action and staff education was not undertaken and 10% of tests were still not authorized by the time service was rendered.
This is just one type of test performed, so imagine the risk when all the other types of prior authorization tests are included. Your staff needs continual education and competency management in order to stay ahead of the shifting regulatory and compliance landscape.
To learn more about other threats to patient record integrity and financial outcomes, fill out the form to view our infographic titled, “Rising Threats to Patient Record Integrity”, to understand the regulatory and marketplace forces that may soon negatively affect your revenue cycle performance if your staff is not adequately educated to address these new risks.
To learn more about Precyse University DNA™, the next generation of education and competency management, click here, to visit our website.