Healthcare Revenue Cycle Management: Close gaps, improve cash flow.
The healthcare revenue cycle involves so many different processes, personnel, and policies, there are plenty of opportunities for glitches and inefficiencies. And without a holistic approach that examines the entire cycle from start to finish, it can be difficult to detect those pain points.
HMA’s Healthcare Revenue Cycle Management team offers that holistic approach. We begin with a Revenue Cycle Gap Assessment to pinpoint those areas where best practices have broken down. Then we help you implement the processes, training, and technology necessary to close process gaps, improve cash flow, determine the root cause, and reduce denials.
The HMA approach to Revenue Cycle Management.
The HMA Healthcare Revenue Cycle Management team uses a collaborative, customized approach to quickly identify revenue cycle issues and address them.
Revenue Cycle Gap Assessment
Our process begins with a thorough assessment of all the key components of the revenue cycle. During this assessment, HMA’s experts will:
- Ask targeted questions designed to uncover pain points, bottlenecks, and inefficiencies
- Evaluate each facet of the cycle against industry key performance indicators (KPIs)
- Review current host systems, electronic technology systems and setups within the entire revenue cycle
- Work with the appropriate representatives to evaluate managed care contracting and ensure accuracy of variances in payor reporting
- Perform data analysis such as risk-based modeling and scenario analysis
- Conduct clinical documentation and coding audits
- Perform chargemaster and fee schedule reviews
Key areas evaluated by the gap assessment include:
- Payor contract management and credentialing
- Scheduling
- Patient demographics validation
- Registration and insurance eligibility verification
- Medical necessity and authorization
- Charge capture and entry
- Procedure and diagnosis coding
- Claim submission
- Third-party payor follow-up
- Patient billing and collections
- Remittance posting
- Denial and appeals management
- Reporting and analysis
- Chargemaster and fee schedule review
Case Study
A revenue cycle management success story: Advanced Diabetes Supply/US Medical Supply
Expert Video
Linda Krish talks revenue cycle gap assessment
Recommendations and Implementation
After the revenue cycle gap assessment has been completed and key pain points have been identified, our team provides customized, data-driven recommendations for process and procedural changes that will immediately improve cash flow.
HMA experts will collaborate with your team to make sure the recommendations are understood and implemented correctly, and provide measurement and monitoring tools to help your organization stay on track.
Some common recommendations and implementations include:
- Updating host system and electronic claims submission system to improve clean claim rate
- Streamlining processes and training personnel to improve accuracy of data collection and registration
- Updating CPT codes and pricing and designing a review process to ensure continued accuracy, thus improving compliance and reducing denials
- Providing scorecards, dashboards, and action plans, then helping to transition your organization to these new measurement and monitoring tools
Every organization is unique, and yours may require different tools and processes. HMA’s Healthcare Revenue Cycle Management team will work side by side with you to find what works best for you.
Who needs Revenue Cycle Management services?
HMA provides Revenue Cycle Management services to public health safety net providers, managed care organizations (MCOs), accountable health organizations (ACOs), academic medical centers (AMCs), federally qualified health centers (FQHCs), and more.
Revenue cycle issues affect many areas of the healthcare system. Learn more about our services for health systems, delivery systems, Long-Term Services and Supports (LTSS) and behavioral health.
If the answer to one or more of these questions is “no,” your organization may have revenue cycle management issues:
- Do you have a low denial rate?
- Are your days outstanding within the industry benchmarks?
- Do you monitor key performance indicators (KPIs)?
- Is your electronic clean claim rate 98% or higher?
- Is the percentage of your Accounts Receivable (AR) more than 90 days less than 15%?
- Are your cash collections greater than 200% of your last two months of net revenue?
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