Provider services and solutions

Financial performance: Revenue cycle and billing processes

The challenge

Your profitability is tied to your revenue cycle. But efficient revenue cycle management—integrating it with your organization’s clinical and business processes—faces myriad obstacles, including multiple payers, complex regulations from federal, state, and local governments, performance- and value-based reimbursement programs, inflexible reimbursement methodologies and consumer demand for billing transparency and comparison shopping that add competitive pressure.

Your revenue cycle begins the moment a patient registers for care. Along its path, data collects around the patient from clinical and financial processes throughout your organization. Verifying coverage. Determining benefits and patient financial responsibility. Managing patient flow. Capturing charges. Coding them accurately. Submitting bills and claims. Offering financial services when needed. Collecting funds from patients and payers. The cycle ends only when a patient’s account has a zero balance.

A well-managed revenue cycle protects revenue and accelerates cash flow. Supported by a strong information infrastructure, it can help you standardize procedures and enable information sharing across operational units. Enhance your overall financial performance. Allow you to better fulfill your mission to serve your patients and community.

How we can help you

• Your revenue cycle processes must comply with government standards and regulations. As public and private payers continue to evolve their reimbursement policies and methodologies, you need to be sure that today’s revenue cycle processes aren’t based on yesterday’s compliance requirements.
  • We can help you understand government regulations that affect revenue cycle policies and processes. We can help improve process compliance with employee education and systematic monitoring tools.
• A well-managed revenue cycle that is integrated with your clinical and business processes should help you reduce operating costs, protect revenue, and accelerate cash flow.
  • We can conduct gap analyses on revenue cycle processes. We can perform statistical analyses of discharged not final billed items, suspended claims, Medicare suspense files, and accounts receivable to identify and recover lost revenue. We can help you revamp your revenue cycle processes to accelerate receivables, reduce bad debt, and enhance net revenue.

Common services include

• Identifying opportunities to recover lost revenue
• Improving the accuracy and completeness of health information management coding and billing for inpatient and outpatient procedures
• Analyzing denials to pinpoint reasons for denied or delayed payment