Revenue Cycle Management
We help you with the entire revenue-generating process, from admission to the patient’s final payment. By using a medical billing software, your organization will be able to realize revenues. We focus our revenue cycle management on end-to-end revenue cycle management solutions ranging from cash posting as well as an explanation of benefits (EOB) processing up to denial management, insurance follow-up as well as self-pay for shorter revenue cycles so that cash flows may increase at a reduced cost.
Revenue Cycle Management Consulting helps to maximize your revenue, keep your offices running, and give you more time to talk to your patients.
Our Service
DPA 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 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 DPA 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
Revenue cycle
The revenue cycle includes all the administrative and clinical functions that contribute to the capture, management and collection of patient service revenue, according to the Healthcare Financial Management Association (HFMA).
Here is what’s involved in the revenue cycle:
- Charge capture: Rendering medical services into billable charges
- Claim submission: Submitting claims of billable fees to insurance companies
- Coding: Properly coding diagnoses and procedures
- Patient collections: Determining patient balances and collecting payments
- Preregistration: Collecting preregistration information, such as insurance coverage, before a patient arrives for inpatient or outpatient procedures
- Registration: Collecting subsequent patient information during registration to establish a medical record number and meet various regulatory, financial and clinical requirements
- Remittance processing: Applying or rejecting payments through remittance processing
- Third-party follow up: Collecting payments from third-party insurers
- Utilization review: Examining the necessity of medical services
