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Related Experiment Videos

Optimize APC revenue with process-oriented assessments.

Michael S Kovar1, Elizabeth Lowery

  • 1KPMG, LLP, Baltimore, Maryland, USA. mkovar@kpmg.com

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|April 20, 2002
PubMed
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Healthcare financial managers can optimize Medicare revenue by assessing revenue capture in key departments. A structured, multidisciplinary approach ensures effective financial management under the outpatient prospective payment system (PPS).

Area of Science:

  • Healthcare Financial Management
  • Health Services Research

Background:

  • The Medicare outpatient prospective payment system (PPS) impacts healthcare revenue streams.
  • Accurate revenue capture is crucial for financial stability, especially in high-impact departments.

Purpose of the Study:

  • To outline a process-oriented approach for assessing revenue capture effectiveness under the Medicare outpatient PPS.
  • To guide healthcare financial managers in optimizing revenue streams.

Main Methods:

  • A multidisciplinary team assessment involving CFO, COO, and departmental leaders.
  • A five-phase process: chargemaster/charge-capture analysis, revenue-capture process assessment, claims review, strategy development, and monitoring.

Main Results:

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  • Implementation of a structured assessment process can improve revenue capture.
  • Identification of key departments (radiology, cardiology, emergency) most affected by PPS ambulatory patient classifications.

    • Conclusions:

    • A systematic, team-based approach is essential for effective revenue capture under the Medicare outpatient PPS.
    • Continuous monitoring and strategic implementation are vital for sustained financial performance.