Revenue Cycle Services

Enhancing financial performance through change management, knowledge transfer, process improvement and technology.

Revenue Cycle Assessment

Our proven approach leverages people, knowledge, technology, and process redesign to enhance Revenue Cycle performance. We utilize an assessment process to identify opportunities to improve revenue capture, accelerate cash flow, enhance performance, and identify solutions that will allow us to determine the appropriate implementation plan and focus efforts that will address the barriers to achieving acceptable key revenue cycle indicators.

Our Assessment Services include:

• Accounts Receivable and Cash Collections Assessment
• Bad Debt and Pre-collect Service Assessment
• Billing and Claims Editing Assessment
• Denials Management Assessment
• Patient Access and Financial Clearance Assessment
• Remittance and Transaction Management Assessment
• Staffing and Organizational Assessment
• Technology Assessment
• Transaction Management Workflow

Accounts Receivable and Cash Collections Assessment

We will perform a comprehensive review of aged accounts receivable. This will include selecting a sample of accounts to evaluate effectiveness of current follow up and collection procedures, and identify root cause problems impacting timely collection of accounts receivable. We will focus on opportunities to accelerate cash collections and the subsequent reduction of days outstanding in accounts receivable.

Cash Collection Assessment

Our assessment includes the following:

• Breakdowns in eligibility determination and concurrent review process
• Delays in the billing and claim submission process
• Delays in the claim adjudication process
• Uncollectible accounts receivable
• System functionality optimization targets
• Enhancements to accounts receivable management reports and follow-up tools

Bad Debt and Pre-collect Service Assessment

Our bad debt and pre-collect assessment services are designed to identify the drivers that contribute to bad debt expense and to evaluate internal and external collection performance, expense, and the return on investment.

We will analyze and classify historical bad debt and pre-collect encounters and provide recommendations for performance improvement initiatives that will allow for reduced bad debt expense. We will also evaluate current in-house and agency performance and provide recommendations for “best practice” to maximize collection performance and reduce cost.

Billing and Claims Editing Assessment

Our billing & claims editing assessment services are designed to evaluate existing technology to identify opportunities to enhance the logic, functionality, and workflow to support a compliant and efficient billing process. Our approach will identify the current state functionality within the patient accounting system and claim editor, review of payer edits, claim acceptance rates, and evaluate staff proficiency in the claim editing process. We also review the claim submission and reconciliation process to ensure balancing processes are in place to prevent lost claims and timely filing denials. The assessment will identify issues with system configuration, claim editing, and claim reconciliation process impacting staff productivity and timely cash collections.

Our Assessment

We will identify the following:

• Claim generation volume and frequency
• Percentage of clean claims by payer and bill type
• Top error reasons by payer and bill type
• System functionality optimization targets
• Recommendations for claim reconciliation, balancing, and denial process

Denials Management Assessment

Our denials management assessment services are designed to assess the impact denials are having on the organizations bottom line, as well as understand the drivers contributing to lost revenue for services rendered.

Denials Management Approach

We will review current state denials reports and payer remittance files to assess the impact denials are having on the aged accounts receivable, as well as, understand the drivers contributing to lost revenue. We will select a sample of accounts to identify root causes and process improvement initiatives to improve revenue capture and prevent denials. We will identify the following:

• Denial activity by payer and denial category
• Targets for revenue improvement
• Process improvement initiatives for denial prevention
• Potential appeals and revenue recovery targets
• Uncollectible accounts receivable

Patient Access and Financial Management Assessment

We will perform a high level assessment of Patient Access, Financial Clearance and Scheduling departments to identify opportunities to leverage technology, streamline workflow, and improve customer service. We will also target opportunities to reduce denials, increase cash collections and reduce bad debt.

Remittance and Transaction Management Assessment

Our transaction management workflow assessment services are designed to assess the current process for managing remittance transactions, denials reporting, and accounts receivable management. Our approach is designed to assess the current state of remittance transaction management and identify opportunities to leverage system technology and transaction standards to automate and enhance denials management, secondary billing, and cash collections.

The Assessment Identified the Following:

• Electronic remittance posting optimization plan
• Electronic transaction posting optimization plan
• Automated secondary billing plan
• Opportunities to drive follow up and cash collections utilizing remittance transactions