What’s Involved in a Revenue Cycle Assessment? How Do Revenue Cycle Experts Maximize Medical Profits?

BusinessManagement

  • Author Robert West
  • Published January 30, 2020
  • Word count 653

A good revenue cycle assessment will help your organization become more profitable.

But what’s involved in a revenue cycle assessment? How can revenue cycle experts maximize medical profits? What actionable steps will revenue cycle assessment experts help you implement? Today, we’re explaining everything you need to know about what’s involved in a revenue cycle assessment.

Areas of Revenue Cycle Assessments

Some organizations perform a revenue cycle assessment on their overall organization, hiring a consulting company to conduct a bottom-to-top assessment.

Other organizations request specialized revenue cycle assessments in one or more areas of the organization.

Typically, revenue cycle assessments focus on the organization’s core areas, including:

• Pre and post-system implementation

• Organizational structure

• Process flow and design

• Vendor performance

• Staff and team performance

• Denials prevention and management

• Functional office metrics

• Key performance indicators

How a Revenue Cycle Assessment Works

During a revenue cycle assessment, our experts analyze key areas of a medical organization to determine areas of improvement. Our experts use their combined decades of industry experience to solve your organization’s revenue issues.

Here’s a more detailed breakdown of how each step of our revenue cycle assessment will work:

Coding and Documentation Reviews: Good revenue management starts with good coding and documentation. Our experts will analyze your organization’s documentation and coding to ensure billed services are supported while adhering to payer mandates and guidelines.

Self-Pay Strategy: Our experts will analyze your organization’s performance for self-pay and self-pay after insurance collections. We’ll assess reporting, point of service collections, liability estimators, patient contact strategies, and third party vendor management, among other areas.

Denials Management: By analyzing your organization’s denials management, we can reduce write-offs and revenue leakage. Our team will help identify clinical and operational denials, outline identify process and workflow improvement opportunities.

Case Management & Utilization: By assessing your case management and utilization, our experts can identify process gaps that could lead to fatal level-of-care denials.

Charge Capture: Many organizations are surprised by the problems that charge capture analysis can reveal. Good revenue starts with a good chargemaster.

Patient Access: How does your organization perform for insurance eligibility, registration accuracy, centralized scheduling, prior authorization, and point of service collections? Our team will assess your patient access to identify areas of improvement.

Coding & Hierarchical Condition Categories: HMI LLC employs experienced coding consultants who assess your organization’s reimbursement risk related to coding. Every day, medical organizations across the country lose reimbursement because of coding and HCC issues.

Accounts Receivable: We can analyze your accounts receivable, then provide support and training to maximize revenue.

Job Shadowing: Revenue cycle assessment can involve employee shadowing and management training, ensuring your organization is capturing revenue from the lowest levels of the organization to the top.

Negotiations with Payers: We can negotiate with payers for increased reimbursement carve outs, enhancing organization revenue.

Dedicated, Long-Term Revenue Cycle Team: After the revenue cycle assessment is complete, we can form a revenue cycle team dedicated to tracking the revenue of your organization long-term.

Outcome of a Revenue Cycle Assessment

The goal of a revenue cycle assessment is to give the client actionable advice they can implement today to boost revenue. Some of the concrete deliverables created by a revenue cycle assessment include:

• A strategic roadmap for improving the client’s overall operational performance

• Identification and breakdown of current revenue cycle issues

• Identification and quantification of opportunities for improvement

• Detailed recommendations for improving key revenue cycle function areas

• Comparison of an organization’s metrics in relation to overall industry benchmarks

Schedule a Revenue Cycle Assessment with HMI Today

HMI LLC specializes in performing revenue cycle assessments for medical organizations across the United States.

Our team has a unique blend of industry, consulting, and system experience, allowing us to analyze your operations and identify ways to improve your performance.

A healthy revenue cycle is critical for organizational success. Schedule a revenue cycle assessment with HMI LLC today.

Dr. Robert West has more than thirty years of executive management experience in health care.

As CEO and Medical Director of American Pathology Resources, Inc., he, for more than twenty years

Currently Working in HMI Corporation as Chief Executive Officer and Chief Medical Officer in July of 2011.

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