Revenue Cycle Optimization

Revenue is the lifeblood of every business, and every hospital, health system, or physician enterprise has some manner of fracture.

Healthcare margins are tighter than many other service-oriented businesses and, arguably, hampered by stringent regulation. Given the narrow margins in healthcare, the importance of the revenue cycle is no less valid in the operation of hospitals, physician groups, or health systems that employ physicians. Unfortunately, institutions continue to underinvest or underestimate the significance of diligence in revenue cycle management and its accompanying components. Through inertia or neglect, the revenue cycle can become a secondary cog in the operations of the business.

Concerning the health of the revenue cycle ecosystem, the devil indeed is in the details in that figures and reports don’t always tell the entire story. More scrutiny may be necessary to determine an accurate picture. What may look like a sound days-in-accounts-receivable (AR) measurement (e.g., 30 days), can actually mask systemic problems in processes and procedures. Further, if data reported to the executive suite and governance boards are inaccurate, miscalculated, or outright corrupt, the C-suite may not learn about the issues until revenue declines.

As collecting and accurately tracking revenue grows increasingly complex, our team provides full revenue cycle assessments for hospitals, health systems, and physician groups.

We turn red ink to black through:

• Performing full micro-level reviews of the revenue cycle. If a central business office (CBO) is involved in an employed model, we review both the CBO and front end processes at the ambulatory practice level.
• Reviewing data and providing analysis to benchmark to best in class
• Identifying revenue opportunities due to lag days, charge capture, coding, inflated write-offs, and accelerated accounts receivable capture
• Examining processes, policies, and procedures
• Considering the interworking between practices and a CBO model to ensure continuity, communication, and feedback
• Reviewing staffing, staff fit, and management span of control
• Assisting clients in implementing change via action plans and prioritization of critical tasks
• Establishing key performance metrics (KPIs) and, if asked, helping to manage the process

Specifically, a standard revenue cycle assessment will include reviewing items such as:

• Revenue cycle management overview (policies, procedures, patient access management, RCM organizational structure, etc.)
• Clinic management structure
• RCM operational assessment
• Pre-visit functions (scheduling, pre-registration, patient financial clearance, insurance eligibility, and prior authorization, etc.)
• Patient visit/encounter functions (check-in, Check-out, patient collection process, time-of-service collections, financial counseling, etc.)
• Post service functions (charge capture, office and outpatient services, hospital and facility services, charge lag, coding, claim submission, third-party insurance follow-up, etc.)
• Remittance processing, rejections/denial management (payment posting, employee metrics, rejections and denial management, credits/refunds, patient collections/statements/bad debt/collection agency, etc.)
• Practice technology (PMS, EMR, etc.)
• Fee schedule/CDM
• Payer matrix (Credentialing, Compliance)

Our experienced advisors explore and identify weak spots in the revenue cycle, quantify lost revenue or financial exposure, and offer best-in-class solutions to gain efficiency of process and increase revenue.