Revenue Cycle Review

The Challenge

Maintaining the status quo can be costly. As health care operating margins shrink, you need to find efficient and innovative ways to capture and collect revenues. If your staff and procedures have been on autopilot too long, you're probably leaving money on the table.

But how do you bring about changes that don't disrupt your operations, or alienate your staff?

Our Service

RCS can help you analyze your current revenue cycle operations and focus on ways to improve revenue capture and collection. Revenue problems rarely stem from a single source; they are most often the result of deficiencies in education, training, staffing levels, workflow, or poorly implemented computer software. Each deficiency must be addressed as part of a coordinated solution to obtain real improvement.

As the first step of our RC Review, we establish baseline measurements of a provider's financial and revenue cycle performance and create applicable benchmarks. We'll send experienced Revenue Cycle consultants on-site to gather the information necessary to provide you with recommendations in the following areas:

  • Scheduling / Pre-registration
  • Admissions / Registration
  • Insurance Verification
  • Charge Processing
  • Charge Description Master
  • Case Management
  • Health Information Management
  • Billing
  • Follow up / Collections
  • Payment Posting
  • Bad Debt / Agency Management

We will complete a detailed operational assessment of the revenue cycle to identify opportunities for improvement, while also focusing on operational and documentary compliance with HIPAA privacy and security standards. We'll then provide a written work plan containing an assessment of your overall revenue operations, and recommendations for the creation, implementation and monitoring of workable solutions.

Our Approach

  • In-depth discussions with senior management to understand concerns and establish the program objectives
  • Customized review of operations, including interviews of key management personnel
  • Hands-on participation by senior RCS staff
  • Validation of key information by appropriate hospital personnel
  • Creation of applicable indices and benchmarks including:
    • Aging Analysis by Payer
    • Unbilled Accounts Receivable
    • Late Charge Postings by Service Area
    • Service to Billing Timeframes
    • Billing to Follow-Up Timeframes
    • Service to Collection Timeframes
    • Claim Denial Volumes/ Amounts /Types
    • Bad Debt / Bad Debt Recovery Levels
    • Credit Balance Levels
    • Cash Collection to Net Revenue Ratio
    • Cost to Collect
  • Detailed analysis and documentation of all significant revenue cycle processes, including issues relating to compliance with HIPAA privacy regulations
  • Timely completion of work, typically completed four to six weeks after obtaining all pertinent information
  • Detailed management report

Benefits

Typical improvements include:

  • Increased accuracy of account information
  • Timely verification and processing of pertinent account information
  • Improved timeliness and accuracy of charge postings
  • Shortened time frame from discharge to final bill
  • Reduced volume of claim denials
  • Reduced AR days outstanding
  • Lower bad debt and charity write-offs
  • Increased cash flow