Healthcare Revenue Cycle Management

RCCS offers healthcare revenue cycle management services to locate root causes of errors and opportunities for improvement throughout every step of your revenue cycle. These errors may be delaying reimbursement and increasing denial rates, which could cost you hundreds, thousands, or (in some cases) millions of dollars in lost revenue. Our revenue cycle consultants will help you optimize every phase of your revenue cycle and set key performance indicators (KPIs) to help you increase your revenue. Within 60 days, we’ll perform a root cause analysis and provide an executive summary identifying opportunities to increase your revenue, along with custom, comprehensive analytics reporting.

Deepen your understanding of your entire revenue cycle from front-end patient services to back-end reimbursement processes. Our consultants will provide you with recommendations for every cycle phase and best practices to implement along the way. You will learn strategies to verify new strategies are working properly, decrease denials, and resubmit denied claims.

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Revenue Cycle Analysis

The Centers for Medicare & Medicaid Services (CMS) requires all organizations to have their revenue cycle practices audited every six months. Whether you’re in need of an audit, or you’ve already been cited for Hierarchical Condition Category (HCC) Risk Adjustment, the experts at RCCS are here to help with every aspect of your revenue cycle. By analyzing key components of the revenue cycle process, we’ll take a deeper look into the current state of your revenue cycle. Our robust revenue cycle management analytics tools can provide custom, comprehensive reports and derive actionable information to pinpoint opportunities for improvement. Your team will gain advantageous insights to improve workflow, efficiency, and profitability, to become proactive instead of reactive to whatever comes their way. Our Revenue Cycle Analysis includes the following deliverables:

  • Monthly KPI report
  • As is/current state of all metrics
  • Benchmarking for KPIs
  • Dashboard of KPIs
  • Monthly presentation and explanation of RCM metrics performance
  • Missed revenue opportunities
  • Denial mapping

Evaluating Revenue Cycle Performance

Once a root cause analysis has been performed, our expert revenue cycle consultants can take a closer look at your revenue cycle practices and begin to take on the identified opportunities for improvement. Some of the common areas for improvement we can begin to optimize include:

  • Credit/Balance Review
    • Refund recommendations
    • Credit balance resolution
    • Clean-up project creation
    • Dashboard creation
    • Statistical sample review/creation
    • Defining “true” system balances
    • Overpayment review/recommendations
  • Accounts Receivable Review
    • Payment posting accuracy
    • Adjustments review
    • Lockbox setup/reconciliation
  • Billing Practices Review
  • Denial Management
  • Payer Reimbursement Analysis
  • Workflow Evaluations
  • Provider Credentialing
    • Dashboard creation
    • Accountability spreadsheet creation
    • SME application assistance
  • Claim Submission & Follow-Up

Training and Education

  • First Pass Claims Process Training/Education
  • Payment posting accuracy training

Consulting

  • Authorization/Pre-Authorization Specialist Services
  • Quality Control/Assurance
    • Process correction
    • Department creation
    • Integrity guidance
  • Centralization/De-Centralization
  • Process Mapping & Improvement

From our 20+ years of experience, we have developed the ability to identify opportunities for front to back-end office operations of your revenue cycle. We begin this process by conducting a SWOT analysis of your current processes to ensure accuracy and consistent coding practices. The analysis consists of conducting interviews and direct observation of key team members to gain deep insights into your work environment and workflows. We are seeking opportunities to improve the overall efficiency and quality of your billing operations. After the analysis is complete, we will create a customized implementation plan that addresses every phase of your revenue cycle and fixes any issues found.

  • Policy Review/Creation
  • OIG Program Creation
  • Trend Resolution
  • Department Development & Strategic Planning
  • Productivity & Benchmarking

The Revenue Cycle Experts

Revenue Cycle Coding Strategies has been the expert in coding compliance and revenue cycle management for over 20 years. Our team of experienced consultants can be trusted to dive into your revenue cycle and seek out opportunities for improvement every step of the way. Our consultants have experience with the following EMR systems:

  • Imagine
  • Epic
  • NextGen
  • eClinicalWorks
  • ARIA
  • Cerner
  • Meditech
  • Optum
  • Athena

Our financial analysts work with several Power BI platforms, including Webi and Domo, to provide customized and comprehensive revenue cycle reporting dashboards.