With new CMS price transparency rules, the continued shift toward value-based reimbursement, and transition to a consumer-centric and highly digitalized healthcare experience taking center stage in 2019, we thought it would be nice to start the year off with a few every-day opportunities you can execute on immediately without the need for any larger strategic vision or plan. Check these off your list in 2019 and you’ll see direct financial improvements no matter what other initiatives you may have underway.

1. Complete a CDM audit or perform a targeted review. Best practice is to review and update your Charge Description Master and corresponding systems every couple of years at a minimum. If you haven’t done so in a while, you’ve got updates to make and revenue falling through the cracks. Ensuring that pricing updates are done regularly and monitoring whether you are accounting for and charging appropriately for all services performed does involve maintenance, but the revenue assurance it results in is well worth the cost.
2. Shore-up high impact areas. Make sure your most important revenue streams are operating at top-notch levels, and that your most impactful problem areas are getting appropriate attention. That means knowing exactly where you might be underperforming or leaking revenue for pharmacy operations, perioperative areas, imaging, and any key specialty services important to your business. On the back end, look at your denials and make sure at minimum you are adequately addressing both authorization and documentation-based gaps on a regular basis.
3. Maximize system integration. Make this the year you truly connect your front-end (clinical, patient access) and back-end (billing, coding, claims) applications & staff. The disconnects are everywhere, even when you think you have your teams organized with the right systems in place. Streamline your registration and clinical charge capture processes for your billers, review and enhance revenue routing logic and workqueue breakdowns, take advantage of new module configuration points and capitalize on best practice. Your system and your staff will thank you.
4. Increase automation & efficiency. The burden felt by staff at the hands of modern-day computerized regulation and EMR use has reached its boiling point, as evidenced by levels of provider burnout and general staff satisfaction with the EMR. All types of health workers are feeling more and more helpless under the burden of their computer systems and administrative necessities, and in many cases, the frustrations are justified. Fortunately, you can address a lot of it with just a bit of specialized knowledge and some dedicated effort put forth. Automate charges, reduce clicks, provide intelligent data summaries and decision support mechanisms, templates and one-click scripts to make requirements quicker and more consistent. The capabilities are all there - make the computer work for your staff, not vice versa. 

The future will continue to bring change to healthcare’s revenue, reimbursement, and EMR landscapes, but by putting only minor efforts forth to ensure that the items above are done optimally, you will set yourself up for improved financial success in 2019 and beyond, no matter the changes that continue to come.  The Wilshire Group wishes you a healthy and prosperous year, and if we can be of assistance in performing an assessment or helping to organize the work you find ahead of you this year, let’s talk, and pair our bright minds with yours.