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Related Experiment Videos

Consortium improves MCO, outpatient billing

    Healthcare Benchmarks
    |January 7, 1997
    PubMed
    Summary

    Unscheduled outpatient visits are a significant revenue source but generate most claims, straining manual billing and collection processes. Optimizing these processes is key to balancing revenue potential with collection costs.

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    Area of Science:

    • Healthcare Management
    • Health Economics
    • Revenue Cycle Management

    Background:

    • Unscheduled outpatient visits constitute a substantial portion of gross revenue (22%) but generate a disproportionately high volume of claims (95%).
    • Current billing and collection processes are largely manual, exacerbated by complex requirements from managed care organizations.
    • This inefficiency leads to increased operational costs and extended revenue cycle times.

    Purpose of the Study:

    • To analyze the financial impact of unscheduled outpatient visits on healthcare revenue cycles.
    • To identify inefficiencies in manual billing and collection processes within a large academic health system consortium.
    • To develop strategies for balancing collection potential with resource expenditure and reducing accounts receivable days.

    Main Methods:

    • The study was conducted at the University Health System Consortium, comprising 27 university hospitals.
    • Analysis focused on the volume of claims generated by unscheduled outpatient visits versus their revenue contribution.
    • Evaluation of current manual billing and collection procedures in response to managed care requirements.

    Main Results:

    • Unscheduled outpatient visits represent a significant administrative burden due to the high volume of claims processed.
    • Manual billing and collection systems are costly and inefficient in managing the complexities of managed care.
    • Outstanding revenue days in accounts receivable are likely prolonged due to these process limitations.

    Conclusions:

    • Streamlining the revenue cycle for unscheduled outpatient visits is crucial for financial health.
    • Automation and process optimization are necessary to address the challenges posed by manual billing and managed care demands.
    • Effective revenue cycle management requires balancing collection efforts with operational costs to improve financial performance.

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