Case #30 in 5th edition - Cases in Healthcare Finance - Gapenski and Pink.

1. a. Using the template given in Exhibit 30.1, add one additional overall benchmark and one defect benchmark for each of the revenue cycle functions listed.

b. Describe each metric in the completed template and provide justification as to why these benchmarks were chosen over the alternatives listed in Exhibit 30.2.

2. Compare the benchmark values in your completed template with the actual MRHS metric values given in Exhibit 30.3. Discuss your results. Most important, suggest what actions might be implemented to improve revenue cycle performance.

3. a. Complete the reimbursement amount template provided in the case for CPT 73722 (MRI of the knee) and DRG 470 (major joint replacement). Discuss the fairness and efficiency of the current fragmented reimbursement system to providers, insurers, patients, and society (the ultimate bearers of healthcare costs).

b. Assume that MRHSs payer mix is 46 percent Medicare, 34 percent commercial/managed care, 16 percent Medicaid, and 4 percent self-payo insurance. Calculate the average expected payment for each of the two procedures.

4. In a single paragraph, describe the revenue cycle and why good performance is so important to Providers.

5. In your opinion, what are three key learning points from this case?

MILWAUKEE 30 REGIONAL HEALTH SYSTEM REVENUE CYCLE MANAGEMENT ANDRE w MAE HAs recently been hired as the vice president of Revenue Cycle Management for the Milwaukee Regional Health Sys tem (MRHS), an integrated system with approximately $2.5 billion in annual revenues. Located in the Milwaukee metropolitan area, MRHS consists of an academic medical center, two community hospitals, and 30 outpatient primary and specialty care clinics. Annually, the hospitals collectively see more than 40,000 admissions, approximately 100,000 emergency room visits, and nearly 1 million outpatient encounters, while the clinics receive more than 1.6 million visits. The vice president of Revenue Cycle Management is a newly cre- ated position at MRHS. In that role, Andrew will oversee the merger of the currently separate hospital and physician revenue cycle depart- ments. Andrew has been directed by MRHSs CEO to accomplish two primary goals: (l) lower the overall costs of revenue cycle management and (2) improve the revenue cycle process. (For more information on revenue cycle management, see the Healthcare Financial Management Association website at www.hfma.org or the Medical Group Manage- ment Association website at www.mgma.com. Search the term revenue cycle at either or both websites.) Andrew understands that the first step in merging MRHS's sepa- rate revenue cycle departments is to alter the current perception that hospital and physician practice revenue cycles are inherently different. in this regard is to illustrate the similarities between and inter- dependencies among the revenue processes to highlight what believes to be the true determinants of revenue cycle success: (l) the MILWAUKEE 30 REGIONAL HEALTH SYSTEM REVENUE CYCLE MANAGEMENT ANDRE w MAE HAs recently been hired as the vice president of Revenue Cycle Management for the Milwaukee Regional Health Sys tem (MRHS), an integrated system with approximately $2.5 billion in annual revenues. Located in the Milwaukee metropolitan area, MRHS consists of an academic medical center, two community hospitals, and 30 outpatient primary and specialty care clinics. Annually, the hospitals collectively see more than 40,000 admissions, approximately 100,000 emergency room visits, and nearly 1 million outpatient encounters, while the clinics receive more than 1.6 million visits. The vice president of Revenue Cycle Management is a newly cre- ated position at MRHS. In that role, Andrew will oversee the merger of the currently separate hospital and physician revenue cycle depart- ments. Andrew has been directed by MRHSs CEO to accomplish two primary goals: (l) lower the overall costs of revenue cycle management and (2) improve the revenue cycle process. (For more information on revenue cycle management, see the Healthcare Financial Management Association website at www.hfma.org or the Medical Group Manage- ment Association website at www.mgma.com. Search the term revenue cycle at either or both websites.) Andrew understands that the first step in merging MRHS's sepa- rate revenue cycle departments is to alter the current perception that hospital and physician practice revenue cycles are inherently different. in this regard is to illustrate the similarities between and inter- dependencies among the revenue processes to highlight what believes to be the true determinants of revenue cycle success: (l) the