Question

In the new value-based reimbursement environment, what other measures can a nurse manager take to enhance reimbursement and prevent revenue loss?

Answer 1

The revenue management must be done so that the services delivered must be paid accurately and on time. The nurse manager must consider certain facts and take up certain measures to promote this.

1. Claims must be clearly understood: They should know the components of claims management and how it affects reimbursement. These include the pre registration services, care process, process integrity practices, billing services, administrative services.
2. Understand who are the stakeholders and how is the process of reimbursement: The administrative leaders from different departments of the health care organization must communicate properly. Have a sharp idea on how different personnel works roles regarding billing of the patient.
3. Knowledge about federal policies: The changes in the federal policies related to reimbursement must be followed closely. Any new additions or changes must be clarified and shared with other health care leaders.
4. Managing the process of processing claims: The billing type can be centralized , decentralized, outsourced or hybrid models. The managers must have a clear idea of which type of billing process is happening in the organization and need to follow it up , so as to get the payment done on time.
5. Review of the revenue cycle: The managers need to do this in order to have an idea about improving cash benefits, reducing cost, and increasing margins.
6. Automation of claims processing: This can be accurate than manual processing.