Emergency department (ED) nursing leadership is increasingly challenged to manage the delivery of not only excellent clinical care and outcomes but also solid financial performance. Many nurses find this responsibility intimidating because few have a strong background in, and understanding of, the processes that support optimal performance. The good news is that every nursing leader can acquire this knowledge and the information in this chapter will start the journey.
Revenue cycle management (RCM) is a hospital function that typically falls under the purview of patient financial services and the chief financial officer (CFO), but successful nurse leaders will need to gain an understanding of how to optimize the revenue in their EDs. Seven process components of the revenue cycle, including patient registration, documentation, charging, coding, billing, monitoring, and follow-up provide an ideal conceptual framework for a discussion about the key processes that determine an ED's financial health (Figure 81-1). By understanding and actively engaging in these processes, nursing leaders can monitor and drive change in these areas if improvements are needed.
Revenue cycle components as seen from an ED perspective. (Source: LYNX Medical Systems.)
The nursing leader will not be the revenue cycle process owner in most cases, but because they are accountable for financial outcomes in the ED, a working understanding and the ability to speak the language will facilitate collaboration with others whose job it is to directly manage these processes. A working understanding will also allow the ED nursing leader to communicate these important revenue concepts and expectations to the ED staff and physicians, whose support is essential for achieving success.
In addition to learning about ED revenue cycle processes, including best practices and important issues within those processes, this chapter will provide the nursing leader with information on compliance issues that impact the ED, a discussion about observation services, and helpful strategies to help ensure financial success.
The Healthcare Financial Management Association and others define RCM as the coordination of “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.”1 These functions support generation of a clean claim, help optimize reimbursement, and are often the focus of compliance efforts, which will be discussed later.
While the ED nursing leader's span of control and responsibilities places them in an ideal position to affect improvement in the revenue cycle, there may be hurdles to overcome. Nursing resources are tight and some hospital chief executive officers (CEOs)/CFOs, and even some in executive nursing leadership, believe that the work of the ED clinical and management staff and ED clinical processes should not be tainted by having to worry about functions traditionally left to the hospital finance group. ED nursing leaders can overcome this notion as they gain knowledge, educate staff, and, through partnership with ...