Revenue Cycle

What’s missing, though, is that most revenue cycle management analysis doesn’t answer the real question: How do we increase profit?

We think there is a different way to approach this challenge: create a customized plan for increasing profit, using proven modeling to identify the most critical and most overlooked opportunities in your revenue cycle.

We call it a “Revenue Opportunity Roadmap.”

The Challenge Most Medical Practices Face, Summed Up: Where Did All the Money Go?

“We’re working just as hard, but receipts are down.” Does this sound familiar?

Revenue Cycle Management can be a daunting task: perfecting the delicate formula of what payers are willing to pay, covering the expenses of the clinic and still have income available for distribution to the providers. Many practices are faced with lower payments, increasing expenses, and stricter compliance issues – which mean even more pressure on profits that are available for distribution to shareholders. With payer’s decreasing their reimbursements each year, are there even any expenses left to cut?

Solution: Revenue Opportunity Roadmap

In working with many practice leaders, we have developed a proven modeling and advisory service that will identify the most critical and most overlooked opportunities in your revenue cycle. In our experience, these are the top areas. However, each practice has unique challenges. What our team offers is help you analyze and prioritize your opportunities.

In other words, our experienced team can help you build a custom roadmap to understand:

1. Where should you start, and
2. Which areas of your practice have the best ROI potential

Most Critical

These are the most critical areas in your revenue cycle management plan. Uncovering opportunities here typically have the best ROI.

Procedure Pricing

Ailment:
Are procedures being priced correctly?

Symptoms:
Without a competitive fee schedule, how would we know if there is missed opportunity? Comparative data to help you solve this problem is difficult to find.

Solution:
Work with healthcare industry experts who have access to the data you are missing, and also have experience navigating complex Sherman Anti-trust rules, laws and regulations.

Outcome:
A clear pricing strategy for beating the competition. Increased profits, with less compliance risk.

Accurate Coding

Ailment:
Why is there a coding and collection mismatch?

Symptoms:
Providers are rarely available when coders have questions. This can hold up the billing process, or lead to “down coding.”

Solution:
Assign specific coders to a specific provider. Educate coders and providers on a regular basis. Hold coder meetings to discuss similar issues.

Outcome:
Provider/coder communication and relationships will improve. This leads to correct billing and coding for services provided.

Staff Performance

Ailment:
Why are we experiencing staff turnover?

Symptoms:
Improper job/skill set definitions leads to unqualified professionals and personality mismatches. Lost revenue and poor employee job satisfaction.

Solution:
Identify leading approaches on policies and procedures for similar specialties. Create a well-defined chain of command and job descriptions that match individual’s qualifications.

Outcome:
Lower overhead and higher profits will result. Employee’s expectations will be better defined. Better employee engagement, higher job satisfaction, and lower turnover.

Unrealized Billings

Ailment:
What revenue are we missing out on?

Symptoms:
Administration feels challenged when someone questions their authority. Coders feel challenged when someone questions their skills. It’s a painful process, so it’s avoided.

Solution:
Identify procedures where real opportunities exist, then establish a competitive fee schedule, which also helps with contract negotiations.

Outcome:
The time and stress involved to develop a billing strategy is reduced. You know (and can show) your practice is not leaving money on the table.

Quality of Referrals

Ailment:
Do we really know where our patients are coming from?

Symptoms:
Business is declining and your practice has no clear way of tracking referrals to get at the cause. Or, the type of referrals are changing and not a match for your ideal patient.

Solution:
Identify who sends patients to your clinic. Develop a plan to track quantity,  quality and trends. Get the facts behind the assumption.

Outcome:
A clear picture will lead to better relationships with each referral source, and better quality of the referred patients for your specialty.

Most Overlooked

You may not even know you are leaving money on the table! With most medical practices, these are unknown and untapped areas for improved profitability.

Denied Claims

Ailment:
Why are our denials above the norm?

Symptoms:
Your internal outstanding receivables report shows claims never paid, and payers “down coding” care. Every payer plays by their own set of rules.

Solution:
Look for patterns of denied claims.Have specific coders work on specific payers and identify a go-to contact person at every payer’s office.

Outcomes:
Income increases while overhead simultaneously decreases. Employees are more productive and happier with fewer frustration of denied claims.

Market Positioning

Ailment:
Are we billing more, or less, than the competition?

Symptoms:
Creating reports is time consuming without prior knowledge. Even then, do you know where to get the industry data to compare?

Solution:
Tap into the right resources – industry benchmarks and analysis are available if you know where to look. Working with outside experts can build your reports, quickly.

Outcome:
Your clinic is more competitive in the marketplace – which can support goals like attracting new patients and increasing referrals.