• Revenue Cycle Analysis

    We provide analytical support and/or outsourcing options for all services below. We believe that a successful Revenue Cycle is the Key to the viability of a Medical Practice.

    Revenue deficiencies are often derived from a number of sources. Each deficiency will be approached as part of a coordinated solution to yield long-term results.

    Our inclusive analysis and improvement approach sets an environment for freedom of ideas and feedback, while eliminating staff alienation and operational disruptions. Areas include:

    • Staffing - Analysis and recommendations for staffing levels, education, training, and workflow.

    • Establish or enhance team meetings to evaluate optimal assignment of current resources.

    • Fee Schedule –Identify areas of revenue capture maximization and payer contract compliance. Comparisons to national KPI’s will be performed to ensure maximum effectiveness.

    • EHR –Optimize use of software and establish greater integration among systems. Utilize software reporting to track and trend: Funding Sources, account reps, providers, services, and locations. Document management: Scanning, file categorization, EOB tracking and retrieval.

    • Documentation and Coding – Utilization of Certified Coders to recommend techniques to ensure capture of all pertinent visit findings. Ensure code selection matches chart documentation.

    • Patient Access – Analysis and operational improvement strategies for: Pre-Registration, scheduling, insurance verification, patient throughput timing, and charge capture.

    • Collections –Develop benchmarks applicable to each service line, funding source, and place of service. Analysis of: Claim submissions, error reports payment posting, account follow-up, and bad debt/agency management. Credit Balance protocols and resolution analysis.

    • Reconciliation – Implement end of day service and payment reconciliation strategies. Develop solutions that ensure all services rendered are identified, captured, and billed.

    Managed Care and Pre-Claim Review Services

    • Credentialing, licensing, and privileges
    • EFT, ERA, and EDI initiation
    • Encounter form analysis
    • Fee Schedule Analysis
    • Payer contract review & negotiations
    • Intake form and policy manual review

    Pre-Encounter Analysis

    • Chart Prep
    • —Telephone Intake Process
    • —Insurance Verification
    • —Appointment Confirmation Process

    Post-Encounter

    • Check-In/Registration
    • ——Time of Service Collections & Reconciliation
    • ——Patient Flow
    • ——Medical Documentation
    • ——Follow-Up Care Plan
    • ——Charge Capture, Coding, and Charge Entry

    Claim Submission

    • Pre-Billing Q/A Review
    • —Coding Q/A Review
    • —EDI & Payer Address Validation
    • —Clearinghouse Edit reporting & resolution
    • Claim adjudication

    Internal Claim Processing

    • Retrieve ERAs and EOBs
    • —Payment & contractual adjustment posting
    • —Post & track denial trends
    • —EFT reconciliation & Deposit of funds
    • —File/Scan/Index EOBs

    Insurance A/R Follow-Up

    • —Denial resolution process
    • ——Unpaid claim investigation
    • ——RAC audits, retractions, & overpayments
    • ——Appeals and medical necessity
    • —Claim escalation

    Patient A/R Follow-Up

    • —COB and Account Review
    • ——Patient Invoicing
    • ——Telephone Collections
    • ——Payment plan systems
    • ——Internal account audits and refunds
    • ——Transfer to collection agency or litigation

OUR SERVICES