The link between discharge planning and revenue cycle management

What drives specific elements of revenue cycle management with respect to discharge planning in hospitals?

Discharge planners’ role in improving the revenue cycle is more proactive than reactive. This means that what discharge planners do during a patient’s hospital stay and how they document it will help the patient accounts department submit a claim likely to be paid without being audited.

Following the process and establishing policies based on the law will go a long way toward avoiding roadblocks in patient throughput, and, should the need arise, an appeal of a later denial.

Clearing up confusion in the discharge process and obtaining administrative agreement will help staff members provide consistent and efficient services. For example:

• Only physicians may discharge patients, so an understanding of their role in the discharge process is essential to managing LOS
• Address delay days because of physician involvement or lack thereof in the discharge process by reviewing with the medical staff what the AMA identifies as their role in the process
• Supporting the collaborative nature of working with patients during the transition process is the best way to manage resources, eventually driving revenue

Using the Conditions of Participation to standardize practice for all members in the department responsible for discharge planning will allow a more streamlined process.

Many efforts aimed at transition management are producing results, but no matter how quickly a patient is transitioned or discharged, the rules still apply. Revenue cycle efforts don’t affect revenue only; they affect compliance and, ultimately, patient care.

Know the rules, establish policies and practices to apply the rules, and work with patients and physicians, and the revenue cycle will improve.

For more information, see Discharge Planning Guide: Tools for Compliance, Fourth Edition, by Jackie Birmingham, RN, BSN, MS, CMAC.