Revenue Cycle Transformation

Patients enter the healthcare system through many avenues, and whether services are planned or unplanned, they’re always personal. Our approach to patient access prioritizes the patient experience by reducing the number of “touch points” for the patient, helping gather the right insurance information, providing more consistent and  simple collection of patient upfront payments, and proactively assisting those unable to pay. During this focused work, we can assist your organization with the following:

• Measure and help reduce referral leakage
• Estimate and help manage patient liability communication
• Develop policies and procedures for financial clearance and financial assistance, including development of financial counseling tools to leverage assistance programs (some geographic areas have 50+ assistance programs available to their patients)
• Align your resources to your organization’s needs through “staff-to-demand” analytics and centralizing certain aspects of your organizational model, where applicable for your specific organization
• Enhance referral coordination, communication, collaboration, and associated processes
• Proactively manage operational KPIs through dashboards and reporting

Accurate charge capture is critical to maximizing reimbursement and improving revenue, but the complexities of the process make it susceptible to breakdowns. We take a holistic approach to your charge capture process, including deep data analytics across your organization, interviews with key stakeholders at the point of care, observing key processes, chart and account reviews, and system interfaces and system capability considerations. We review your organization’s charge master, analyze your revenue and usage statistics, conduct deep data analytics including multiple algorithmic and correlation comparisons, review third-party payor contracts, conduct claim reviews, and consider current state and federal regulations to identify areas of opportunity in your charging practices. Some of the focus areas include:

• Identify revenue “black holes” in the charge capture process and reduce potential lost revenue
• Validate that service prices are appropriate, defensible, and strategic based on comparative data
• Provide structures and processes to support that new and existing services are documented and charged accurately for appropriate recognition of services performed
• Update the CDM and other supporting dictionaries, as applicable
• Implement workflows and reporting to monitor the charge entry and reconciliation process
• Provide education and coaching at the point of care to augment clinical staff engagement and improved understanding of impact to the organization

The goal of case management is to get the patient the right care, in the right setting, at the right time – and cost-effectively. Our comprehensive case management solution optimizes staffing and workflows along the entire continuum of care to drive optimal access, patient health, and use of resources. We focus on the following:

• Ensure the right level of staffing via organizational model assessment and redesign and staff-to-demand analytics
• Define and align roles and responsibilities more clearly in case management, utilization management, and social work
• Standardize clinical denial and appeal processes
• Improve discharge and transition planning with workflow improvements and staff training
• Enhance post-acute care coordination, communication, collaboration, and processes
• Provide management dashboard and metrics

Even small losses driven by payor denials and administrative burdens can amount to millions of lost dollars for a health system, which ultimately means losses for the patient and the community. Here are some of the areas where we focus:

• Identify losses and root cause issues
• Develop tactical plans and help implement change
• Provide staff-to-demand analytics and strategies
• Define vendor strategy and usage
• Support managed care strategies and negotiations
• Strengthen patient liability management
• Improve accuracy of bad debt processing
• Enhance charity identification and recognition
• Provide algorithms to measure actual results
• Provide coaching and training
• Develop executive and management dashboards and metrics