HQM Consulting for Healthcare Quality Metrics


Health Information Management (HIM) is challenged since the Affordable Care Act, the implementation of ICD 10, Value Based Purchasing initiatives, and MACRA, and it is imperative that the hospital’s leadership invests in a robust revenue cycle team.  

HIM has many challenges they are facing including:

  • Lack of skilled resources: many organizations have struggled to find the right personnel with the skill set to, accurately code ICD 10 specifications, project management, clinical documentation improvement, denials and other revenue cycle functions.
  • Escalating Costs and Narrowing Margins: Decline in Medicare, Medicaid & commercial reimbursements are forcing executive leadership to review workflow processes to increase efficiencies and automation to save on expenses.
  • Market Changes: With the new political environment, there is no way of predicting what will happen to the Affordable Care Act, and hospitals will continue to be challenged with the fluctuating amounts of insured and uninsured patients.
  • System Integration: Revenue cycle systems tend to be isolated into siloes resulting in lost revenue opportunities.
  • Clinical Documentation requirements to support ICD 10, meaningful use, as well as hospital acquired complications


Billing and Claims management: It is imperative that leadership address reducing denials and rejected claims. Provide training to staff on denial management processes, point-of-service collections and decreasing the days in patient billing resulting in improved revenue cycle reimbursements/productivity

HQM Consulting can provide an audit and assessment of your coding team to assess:

  • Educational & training opportunities
  • Policies & procedures
  • Workflow processes


  • Example: Bill hold on all HACs to be reviewed by CDI/QA & Provider
  • Example: Bill hold on all Deaths to be reviewed BY CDI/QA & Provider


HQM Consulting will collaborate with executive leadership to design a targeted plan that is going to systematically drill down in the revenue cycle process, from the front end to billing and claims management to dashboard reporting.

REVENUE CYCLE

the Healthcare Quality Matrix

HQM Consulting

Healthcare Quality Metrics