At many hospitals, the clinical and financial teams have different daily operational goals that include good quality patient care along with an accurate charge description master (CDM) and charge capture. With the separated objectives, many organizations are experiencing a divide between these vital operations. Technology has the ability to bridge the gap between the clinical care and revenue, creating operational connections and helping these distinct groups discover new collaboration opportunities.
The verbiage that clinical and financial staff use to communicate with each other differs significantly. Much of the medical vocabulary is based on complex, multisyllabic, Latin-based terminology. Clinical employees speak in the realm of patient care–tests, procedures, medications, conditions, and the like.
In contrast, the financial revenue integrity teams communicate using the terminology of code sets that are required for charging and billing. Revenue integrity employees translate the language of patient care into codes used in the CDM and charge capture.
From a technology perspective, this clinical and financial divide is sometimes more of a deep chasm. Clinical and financial teams may use completely different platforms and systems, or at the very least, separate modules of the same system.
For some hospitals and health systems, the key to reducing that disconnect may lie in adopting technology that can contribute to the much-needed connection of clinical and financial activities, goals and languages.
Creating evidence-based, connected systems The challenge is determining the right technology systems to connect the clinical-financial divide. By coupling clinical software (such as computerized physician order entry and decision support tools) with financial systems (such as accounts receivable and data analytics), hospitals can have a bridge. Such a system is capable of assessing the medical care that hospital providers have ordered and joining that with individual patient charges and codes on the claim. Additionally, a connected system can determine if the CDM and patient claims accurately reflect the care and even identify additional charge-capture opportunities.
Using evidence-based care guidelines as the foundation for a system that bridges the clinical-financial gap strengthens the platform by starting with the best care. This approach helps hospitals to provide the most current care that improves outcomes for patients. Physicians (who want to provide the best, evidence-based care to their patients) as well financial teams (who focus on ensuring that the hospital CDM and charge capture methodologies accurately reflect medically appropriate care) would equally benefit.
