Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid


Education Investment Strengthens Revenue Cycle Management

Lack of staff training remains a top concern for providers. Health plans must improve their provider education process to execute a strong and steady revenue cycle management.

By Jacqueline DiChiara

- The secret to revenue cycle management success may lie in education. Healthcare executives are beginning to understand the monetary value of education and its effect on revenue cycle.

revenue cycle management

But staff preparation levels are still a top concern for healthcare providers, especially when it comes to revenue cycle management.

“Internally, all healthcare facilities should have an education component. Hospitals are losing money,” stated Ginalisa Monterroso, CEO of Medicaid Advisory Group, to

“Everybody's walking in with the wrong insurance. Everybody's walking in with the wrong drug coverage. What the executives are missing internally is that education component.”

An uneducated, poorly trained staff hurts revenue

Lack of communication or misunderstood information may keep claims from being properly coded.

As healthcare consumers become increasingly saavy, they demand more information from their providers.

One reason a clinical billing staff may be ill-equipped is when basic provider directory information is incorrect. Network providers consequently suffer.

Health plans “are going to have to improve their provider education processes to make sure network providers understand exactly which products they're participating in,” said Brian Hoyt, Managing Director at Berkeley Research Group, to

One strategy is to enlist the help of physicians or trusted healthcare providers to instruct educational sessions. A strong focus on building rapport between teacher and student is key.

Bringing in trusted healthcare providers may remove doubt about whether an educational session will actually make a positive impact and ensures educational objectives are soundly met.

But trapping your coding staff in a makeshift classroom or stuffy conference room for nine hours may not be the most effective strategy. Spreading out sessions into smaller bits will not only promote sanity but will save money and foster greater comprehension and dissemination of needed educational revenue cycle information.

“Educational theory clearly says that that sort of information overload is not going to get the outcomes that these coders have to have.  They need to understand the code set and be able to use it, and one nine-hour marathon isn’t going get them to that result,” explained Michelle Leavitt, Director of Courseware and Product Strategy at HealthcareSource, to

Consider ICD-10 implementation and its heavy focus on maximizing staff preparation levels. But not all billers, coders, and clinicians were adequately prepared, even with the knowledge more needed to be done to ensure proper coding and documentation.

Staff training remains a top concern for healthcare providers; nearly 20 percent of surveyed Xtelligent Media readers said levels of staff training were a top concern.

How long should a training session or series of educational workshops last? The American Health Information Management Association (AHIMA) recommended a minimum of four-hour training sessions for a typical coding staff to complete a 60-hour long training session.

Maintaining value and avoiding medical error with education

Indeed, 60 hours of educational training takes money and time. But a well trained staff privy to educational advancement may promote return on investment.

Inadequate educational training naturally stresses out employees. The burnout rates for nurses and an RN staffing shortage, for instance, may be negativity affecting patient outcomes.

According to research from Press Ganey, a low rate of turnover leads to lower readmission rates for Medicare patients with heart failure, myocardial infarction, and pneumonia.

The real focus needs to be on educational and training opportunities within an education system that truly values academic growth, Press Ganey said.

Paying attention to the basics helps: How much will it cost to hire instructors? What does a suitable class timeframe looks like so education sessions do not overlap with a staff member’s general responsibilities? If sessions are too long or too frequent, will general productivity levels dissipate?

Education sessions may be expensive, but so is a lack of training. Medical errors and preventable infections result in unnecessary spending. For example, twenty-three hospitals in New Jersey paid a whopping $500,000 penalty for medical errors. And preventable hospital readmissions reportedly cost the Centers for Medicare & Medicaid Services a whopping $17 billion in 2015.

Nonetheless, if hospitals and healthcare organizations take education more seriously, perhaps return on investment is one step closer.


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