Streamlining Hospital Revenue Cycle Management with Gretchen Case The Wilshire Group

Empowered Patient Podcast

Gretchen Case, Managing Partner at The Wilshire Group a boutique healthcare revenue cycle consulting company that helps healthcare clients streamline workflows and processes. They work with hospitals, physician groups, and other providers to optimize their investment in technology and improve patient outcomes. Gretchen points out the various aspects of revenue cycle management, which include insurance benefit verification, explanation of costs, and identification of financial support. The middle revenue cycle includes the codification of clinical data and coordination with insurance companies and electronic health records. The third phase is the billing and payment.

Gretchen elaborates, "Some of the automation I’ve seen over the last several years has been designed to query the documentation and come up with suggested codes, called computer-assisted coding. And there is a lot of that in play. I think it expedites things and it makes things more efficient. I don’t know of anybody who’s just flipped that button and left it behind and not continued to monitor and manage it."

"There’s also movement right now around what we call a single path. That’s just one way of saying it, but it’s about coding the professional and the technical at the same time. What does that mean? The physician’s procedure charge and the technical is what the hospital is going for that technical component of the services. And a lot of times, we share codes. So, if you’re going to be coding the physicians and getting her bill out the door correctly, you might as well be coding the hospital one at the same time. So there are definitely developments there, but I haven’t seen anything. Just completely automate it and step away."

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