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The Revenue Cycle Management Task Force of the Heathcare Information and Management Systems Society is addressing the next generation of revenue cycle management processes and tools. Payers, providers, vendors, and consultants are involved. Front-end processes such as patient access, business analytics, and point-of-service collections are a key focus. Patient access will need new technology or updated legacy systems. Patients will be able to manage their care with a single portal.

Auditors could look at quality issues as part of the continuum of care, such as readmissions. Pilot program provides information about RACs but not much information about MICs, which could vary by state. Largest providers in largest population centers likely to be first MIC targets.

Develop a committee to deal with MICs and commercial insurance auditors. Define the record request by type and track deadlines, which may vary. Make sure letters from auditors are looked at directly by the appropriate area.

Taking a solid business-like approach to the management of your ED involves--but is certainly not limited to--getting a handle on revenues and expenses. Here are a few strategies some ED managers say help them run a tighter, and better, ship: Have a clinical audit specialist review charts, and have a clerical person "check the checker." Use a "cultural fit" interview with prospective staff members to ensure you're on the same page when it comes to service. Develop a charge structure with numerical values for clinical activities and services, to help ensure optimal reimbursement.

The best way to limit the damage to your department from arbitrary insurance reimbursement reductions and delays is to be proactive. Learn all you can about the appeals process and be on guard for subtle signs that the insurer's payment procedures may have changed without any formal announcement. * When negotiating a contract, be sure to have a billing and coding expert accompany you. * Regularly compare your volume statistics with your revenues to spot sudden substantial discrepancies. * If you suspect a change in reimbursement procedures, conduct a random audit of at least 100 charts.