In the dynamic landscape of healthcare, the traditional Hospital Information System (HIS) primarily focused on capturing facility and technical revenue, often leaving professional revenue as an afterthought. While modern HIS systems have improved, capturing professional charges presents unique challenges that demand exploration for potential enhancements.

1. Capturing Professional Charges:

HIS systems have evolved to support professional revenue capture more efficiently. Imaging and laboratory systems illustrate a 1:1 component of technical to professional revenue, streamlining charge posting.

2. “Automating” Documentation-Driven Charges:

Documentation-driven charges, such as Consults, ED Visit Notes, and Surgery Reports, can be partially automated. Challenges arise in cases where providers dictate reports, necessitating abstract coding or coding software for proposed CPT codes.

3. Bridging the Revenue Gap:

HIS vendors provide Ambulatory or Provider modules for hospital-based clinics, aiming for seamless care delivery. Professional coding and claims in ambulatory settings differ, requiring tailored solutions for effective revenue capture.

4. Capturing Relative Value Units (RVUs):

Providers need to ensure proper credit for their work, involving differentiated claims based on services and locations. The challenge lies in capturing Relative Value Units (RVUs) for physician services, considering various work locations and credentials.

Challenges and Opportunities:

Navigating the nuances of professional charge capture, coding, and billing in a system historically focused on facility revenue is undoubtedly complex. Maximizing the potential of embedded solutions within the HIS is crucial for optimizing the professional revenue stream.

Looking Ahead:

If these challenges resonate with your healthcare organization, taking proactive steps is essential. Medvise would be a great strategic move.

In conclusion, understanding the full spectrum of options within your current HIS and leveraging them effectively ensures that healthcare systems capitalize on embedded solutions, ultimately maximizing their professional revenue stream.

Are you grappling with professional revenue challenges? Consider initiating a conversation to explore potential improvements and maximize the benefits of your HIS with Medvise