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What is the Mid-Revenue Cycle? How Do I Measure Success?

by Laurie M. Johnson, MS, RHIA, FAHIMA

What is the mid-revenue cycle? The middle of the revenue cycle consists of four key components: clinical documentation, case management, charge processing including the charge description master, and coding.

  • Clinical documentation is capturing the accurate picture of the patient’s presentation and care to the healthcare organization whether it is inpatient, outpatient, or physician office. CDI will impact your case mix index, Evaluation and Management levels, and Hierarchical Condition Categories reporting.
  • Case management ensures that the patients are placed in the accurate patient status and are efficiently discharged to the appropriate place after discharge. The accuracy of the discharge disposition can financially impact the facility/organization through shared reimbursement methodologies.
  • Charge processing is capturing all the patient’s charges in a timely manner using the tool of the charge description master (CDM). This file is a list of all services, tests, and supplies that are provided to patients.
  • Coding is the process of reflecting the clinical documentation and charges through ICD-10-CM/PCS or CPT codes. The coders review the clinical documentation and translate the words into codes to paint the picture for the payer.

Measuring your success in managing the mid-revenue cycle takes work and attention. There are key questions that must be answered:

  1. Do I know what my MCC/CC capture rate is?
  2. Do the clinical departments reconcile the schedule with charges daily?
  3. What is my late charge level?
  4. When was the last comprehensive coding audit? Did the coders receive education related to the results of that audit?
  5. What is my Discharged Not Final Coded number? Is it appropriate for my facility?
  6. When was the last time the CDM was updated?

Watch for my next blog where I will provide more information on measuring the success of your mid-revenue cycle.

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Laurie M. Johnson, MS, RHIA, FAHIMA
Laurie M. Johnson is a senior consultant at Revenue Cycle Solutions, LLC, a revenue cycle consulting firm specializing in revenue cycle assessments and work plan implementation; interim management with focus on process improvement; and revenue cycle education for hospitals and physician practices. Laurie is a past president of PHIMA and author of clinical coding articles for Journal of AHIMA and ICD-10 Monitor.

About the Author

Libman Education
Libman Education Inc. is a leading provider of training for the health care workforce offering self-paced and instructor-led online courses designed and developed by leading industry experts in Health Information Management (HIM) and Medical Record Coding. Our courses are specifically designed to improve individual skills and increase the efficiencies and competencies of health care providers and institutions. At Libman Education, we understand the needs and challenges of a well-trained workforce and offer the right-mix of online education to ensure that the health care professionals are prepared to meet the challenges of the changing workplace.

One thought on “What is the Mid-Revenue Cycle? How Do I Measure Success?

  1. Karen - March 5, 2019 at 10:15 pm

    Great synopsis of the Middle Revenue Cycle. I am looking forward to reading your blog.