Operate at the Highest Level Possible
Our Revenue Optimization Program focuses on ensuring that your organization is operating at its highest level. We will spend time reviewing your current day processes from a variety of angles similar to the Revenue Cycle life span.
We will review in-take and patient throughput, charting and coding, claim generation, claim submission, and claim resolution. After the current state analysis, we will work with you and your team to develop an optimization program your organization can implement in-house and/or transition to our organization.
When Do You Need Us?
1. Lack of Oversight & Reporting
The cornerstone for highly effective medical billing is accountability and transparency
2. Inconsistent Cash Flow
Effective medical billing will level out the extreme peaks and valleys of your cash flow
3. High Amounts of Denials
Goal denial rate of 5% or below. A denial rate of 10% or higher indicates medical billing issues
4. Gaps in Billed Amount vs Paid
Large gaps in billed amounts vs paid amounts can indicate poor medical billing practices
5. Untimely Payment Posting
Failure to post payment for your medical billing claims leads to difficulty collecting denied claims
6. Repeated Denials
Consistently being denied for the same reason points to ineffective claim follow-up
7. Delayed billing after service
Claims being billed long after the service was performed are more likely to be denied
8. Lots of Medical Records Requests
Inaccurate medical billing leads to increased scrutiny by healthcare payers
5 Key Strategies
1. PRE-BILLING ANALYSIS
All claims are put through a pre-billing review to find errors in billing codes, authorizations, eligibility, or various other errors based on payor rules, common coding edits, and industry standards. This cuts down on denials due to simple billing mistakes
2. BILLING TASKS
Once the claim passes our pre-billing screening, claims are formatted on the proper billing form for the specific insurance and submitted electronically directly to the insurance company or in some instances they are mailed to the payor if they are not set up for receiving electronic claims.
3. CLAIMS TRACKING
Once the claim has been submitted to the payer, the claim goes into our claims tracking database. This tracks the claim from initial receipt by the payer through every step of the processing until it is ultimately paid or denied. We have developed a set of work queues that drive unpaid claim to a follow-up team group who is responsible for securing payment from the responsible party.
4. AR MANAGEMENT
Payments received are applied to the claims and any unpaid amounts are put into our Denial & Underpayment Management database. These claims are moved up in priority to be sure we resolve the denial or underpayment issue as quickly as possible.
5. BILLING ANALYTICS
Major League Baseball uses analytics to decide who should bat against what pitcher. Why shouldn’t you have analytics that tell you what payers to focus on at what point in the revenue cycle? We track every event that takes place with your claims, allowing us to build analytical reports that show exactly how your organization is performing.