Revenue Cycle Consulting-Overview

Net revenue realization, cash flow and patient satisfaction are all dependent on the effectiveness of an organization’s revenue cycle. Our consultants understand the complexity of your environment, have significant experience across the continuum of the revenue cycle, and bring in-depth knowledge of compliance issues, billing regulations, productivity and staffing benchmarks, and information systems.

Cash Acceleration

Efficient cash flow is the lifeblood of your organization’s financial performance. Of course, the variant demands on your organization’s time and talent can make diagnosing timing and cash flow challenges difficult. Through an analysis of your cash and receivables position, we help you identify, prioritize and implement solutions for immediate improvements to days’ cash on hand.

We also identify underlying causes of extended payment cycles and create long-term strategies to improve Accounts Receivable levels and overall cash flow while decreasing the cost of collection. From identifying effective staff productivity targets to implementing A/R follow-up tools, we can help you improve your receivables performance, cash position and overall financial standing.

Net Revenue Enhancement

Increasing net revenue adds significant dollars to the bottom line. Yet, the complexities managed care product requirements, evolving payment methodologies and tight claims submission timelines present tremendous challenges.

Our experts look across the entire revenue cycle to identify net revenue enhancement opportunities. We start by reviewing patient access processes to ensure that accurate and complete information is being captured up-front, during the scheduling and pre-registration processes. We also help you ensure that eligibility and insurance verification and financial counseling is structured to identify accounts that require financial clearance activities or Medicaid, charity or payment plan assessments prior to service.

Next, we evaluate your Charge Description Master (CDM) line-by-line to ensure services are coded correctly. We also review your pricing strategies to ensure your processes and policies for charge capture deliver timely and appropriate charge identification, charge entry and reconciliation with claims payments. Ultimately, we help you receive equitable reimbursement for the services delivered.

Process & Technology Evaluation and Improvement

With the complexity of the revenue cycle process and the sheer volume of patient encounters, ensuring the proper flow of financial and clinical information can be a challenge. Our specialists can help you evaluate and improve your revenue cycle for optimal functioning at every department level.

First, we complete a thorough review of business processes, staffing levels, job functions and descriptions, reporting structures, and policies and procedures. Then we compare those findings with best practices and make strategic recommendations to restructure complex business functions, redesign processes and help you achieve operational excellence. We understand that implementing these strategic initiatives leads to culture changes, so we work diligently to develop a respectful working relationship with your teams to earn their trust. We can also assist with change management initiatives to ensure successful and sustainable results.

If our evaluation identifies a need for a new revenue cycle system, we can work with you to evaluate, select, implement and optimize it. Whether that’s patient accounting system conversions; enterprise master patient index installation and optimization; or contract modeling, denials management and underpayment recovery systems, we help clients with the infrastructure to facilitate the proper flow of clinical and financial information across the enterprise.

RAC Support Programs

CMS’ Recovery Audit Contractors (RAC) program has proven complicated, challenging and costly for affected hospitals. You can be proactive by preparing for, reacting to, and managing the RAC process. Our consultants help with RAC audit prevention and preparation by identifying where errors are being made, so they can be corrected before an audit begins. Our comprehensive program includes everything from mock and shadow audits to appeals support and analytic reports.

Regardless of what phase you are in—already been audited by a RAC contractor, slated to be audited, or not yet scheduled for RAC audits—we can help you educate stakeholders, identify and address areas of exposure, and assist with process improvement and/or appeals to minimize the effects of RAC.