Firstly let’s start by removing all the (TLAs) ‘three-letter acronyms’ that no one understands” This has been the downhill for many new managers who are hired to bring in a fresh perspective to RCM operations. Few such new managers have the courage to engage head-on and disseminate what each acronym means and get themselves and their teams up to speed or change things around to better suit the industry in the future. The others give in to the larger forces, not wanting to be challenged or mocked at but there is surely nothing but failure and more delays down that path.

Healthcare RCM terminology and acronyms can be divided into 2 groups

1. The acronyms that the industry recognizes Ex: RCM, PMS, HIS, EDI, ERA, EFT, ACH, ICD, CPT, CMS, CMS1500, UB04, HIPAA, and the list goes on.

Anyone who is not familiar with any of the above is not your ideal team member

2. The acronyms that are created within your organization that convert 30% of all communication into codes that only the company veterans would understand. I have seen cases where the CEO of these organizations sometimes struggles to keep up. Ex: ABC (Allied Billing Partner), DS vs NS (Day shift vs. NS), TR (Training Room), CH (Clearing House). I burst out when sometimes the standard industry norm acronym is used for a completely different purpose. It also reminds me of the bizarre additions we saw to the ICD list when ICD 10 was published. Here are some of them that will hurt your tummy.

  • V97.33 (Sucked into the jet engine)
  • W22.02 (Walked into a lamppost)
  • X52 (prolonged stay in a weightless environment)
  • Z63.1 (Problems in relationship with in-laws)
  • Y93.84 (Injured while sleeping)

Coming back: A company that is planning to go international, target large private equity or public offering will need to seriously clean up shop internally. Over time, unless guided by a professional the KPIs that are measured and the SLAs set in place can be counter-intuitive, even worse never looked at by a senior representation to drive action. A famous CEO once said that you can have all the information in the world but the only information that matters are those that are actionable.

We have identified 2 KPIs that drive Healthcare RCM. As long as these 2 KPIs are monitored and improved under a compliant and regulatory framework, any RCM company can gain a strong competitive advantage:

1. How much are you collecting for your client

2. How fast are you collecting them

A lot ponder upon and digest. It all of a sudden questions the 20-page executive summary you are used to and the hours of internal operations meeting that you dread. It does not have been so bad. They are simply exciting changes that can be implemented to get your teams on board and ready to build a world-class Revenue Cycle Company.


AuroraRCM LLC.

2021-05-09 00:29:52

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