The Importance of a Clinically Driven Revenue Cycle to Improve Outcomes and the Bottom Line

In a busy ED where physicians see a broad cross-section of conditions, this can be challenging. But this one decision can have significant ramifications on the hospital’s bottom line. The problem stems from insufficient evidence-based documentation with which to support this decision. Without that insight, hospitals face increased denials from a variety of factors—especially medical necessity—not to mention poorer outcomes that, in and of itself, can negatively impact the bottom line.

This is especially problematic as hospitals grapple with the COVID-19 pandemic. As we’ve learned over the past several months, COVID patients presenting with multiple co-morbidities make care decisions even more complex. And managing the COVID claims process is now just as complex with the uncertainty of when to bill through the CARES Act, when to bill through the payer, or when to bill the patient.