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.
Meet our Revenue Cycle Management experts.
Our Healthcare Revenue Cycle Management team has decades of experience in every facet of the revenue cycle. They’ve been in your shoes; our experts come from all sides of the healthcare industry, including providers, payors, managed care organizations, and more.
Meet the MARSI team: An invaluable resource for HMA clients.
For more than 30 years, MARSI (Medical Audit Resource Services, Inc.), an HMA Company, has specialized in medical coding support, auditing, compliance, and optimization, as well as Healthcare Revenue Cycle Management. They also offer education to providers and staff members to improve the accuracy and compliance of coding and documentation. With MARSI on our team, HMA is able to provide the most in-depth revenue cycle knowledge and services in the industry.
Linda Krish talks importance of revenue cycle
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:
Front Office Responsibilities
- Payor contract management and credentialing
- Patient demographics validation
- Registration and insurance eligibility verification
- Medical necessity and authorization
- Charge capture and entry
- Procedure and diagnosis coding
Back Office Responsibilities
- 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
Interested in an overview of the 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.
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?
Case study: Large urban safety net hospital gets large cash-flow increase.
A safety net hospital in a large urban area approached HMA for help addressing its revenue cycle management inefficiencies. HMA performed a revenue cycle gap assessment and found multiple areas for improvement.
After the gap assessment was completed, the HMA team:
- Implemented a Revenue Cycle Acceleration team in registration, provided education sessions, and conducted daily quality registration reviews to increase accuracy
- Collaborated with hospital personnel to streamline the front-end Charity and Medicaid application process
- Completed the chargemaster and fee schedule description review, updating current procedural terminology (CPT) codes and pricing, including the charge capture reconciliation process
- Developed a revenue cycle dashboard to monitor and measure KPIs
- Implemented updated electronic claims submission system
Impact and Outcomes
- Registration accuracy rate increased from 55% to 95%
- After updating the electronic claims submission system, the clean claim rate soared from 45% to 94% daily, increasing cash collections and improving AR days outstanding
- Physician documentation and coder accuracy rates increased from 83% to 91%
- Cash flow increased by $3.9 million in one fiscal year
Ready to talk to a Healthcare Revenue Cycle Management expert about your project?
Schedule a Consultation