Let's talk about your Revenue Cycle Management (RCM).
Healthcare revenue cycle management (RCM) is defined as the flow of provider, patient PHI, clinical, and financial data (PPC$) through people, processes, and a myriad of technologies. From a systems perspective, PPC$ data flows through multiple internal (provider) and external (payer) revenue cycle event-driven process chains (EPCs) via the electronic data interchange (EDI).
Due to the changes in the healthcare environment as a result of Covid-19, shift to value-based medicine, changes in payer policies and processes, legal and regulatory pressures, mergers and acquisitions, and technology-driven innovations (artificial Intelligence, big data, and machine learning), managing the provider revenue cycle has never been more challenging.
In taking a “holistic/cradle-to-grave” approach, our goal is to enable our clients to optimize their provider revenue cycle in achieving the revenue cycle management “triple aim” of improving system performance, accelerating cash flow, and increasing practice profitability in reducing the excessive administrative burdens often associated with medical practice billing.
Revenue Cycle Management requires discussions and planning.
Reliance℠ can review and assess your current approach and design a tailored solution for you and your staff to do what you do best...treat your patients.
We take a Holistic Approach to achieve results for you.
Achieving a medical practice revenue cycle “triple-aim” (improved revenue cycle performance, accelerated cash flow, and increased practice profitability) requires high visibility into speed of and accuracy of patient personal health information, as well as, clinical and financial data (otherwise known as “PPC$”) all throughout the provider revenue pipeline.
This process and data-driven provider revenue pipeline is an organized, visual way of tracking the speed of accuracy of PPC$ data from cradle (patient access) to grave ($0 balance accounts) through dashboard visualization of KPI’s and flexible ad-hoc querying capabilities.
Are you looking at the whole picture?
A good way to assess the health of your revenue pipeline is to examine areas where inefficiencies, errors, and problems (in other words “pain points”) occur which hamper clean claim submission, and your ability to be agile in implementing strategic and tactical solutions to optimize profitability of your practice.
The Reliance® REVENUE HEALTH ASSESSMENT
This is an outcomes driven “mini-assessment” of your revenue cycle involving insights into accounts receivables highlighting inefficiencies which might be present in your “upstream processes” such as: credentialing, enrollment, contracting, patient access, encounter processing, claim coding, claims submission, and more.
REVENUE CYCLE MANAGEMENT AUDIT
During our full revenue cycle management audit we review and scope out all of the multiple entry points involved in a provider revenue cycle pipeline. By leveraging process analysis, technology, and flexible reporting applications, we can map, combine, and display information in various forms providing medical practices with the ability to derive information from data, detect data patterns and correlations, and spot trends.
These emerging pictures can provide actionable insights which enable process improvement, trend analysis, and forecasting that can drive evidence-based decision making with greater agility, speed, precision, and consistency.
MEDICAL CHART AUDIT & REVIEW
Accurate and full reimbursement for services rendered starts with the “medical record”. The purpose of a medical record is to document services provided to the patient to verify the legitimacy of billable services, and according to the AAPC, it also serves as a legal document describing the course of a patient’s treatment.
Our certified coders will examine patient encounters/medical records to determine what
primary and ancilliary services we performed to determine if the documentation is compliant, medical coding is accurate,
and if charges were entered correctly based on your carrier and/or contractor policy requirements. During a medical chart
review/audit we can examine:
COVID-19 INTERIM MANAGEMENT & SUPPORT SERVICESOur interim services are focus on providing “as needed, temporary services” for in-house medical billing teams in need of additional help or resources to get practices “over the hump” in dealing with delays or backlogs processing claims in their revenue cycle. We can assist in:
Implementing and processing telemedicine claims billing
Verifying Benefits Eligibility and Securing Prior Authorizations
Claim Denials Management, as well as, researching and processing Claim Appeals. Cash Posting and A/R Reconciliation
Monitoring & Tracking Aging Reports