Revenue Cycle System Optimization

Financial performance and bottom-line results are the key concerns of healthcare organizations today.  For many hospitals, revenue cycle processes are not performed optimally.  In a healthy revenue cycle, the healthcare organization achieves a high performance by consistently providing accurate information to those who need it, complete and accurate charge captures, adequate clinical documentation, timely coding, and timely billing – all of which engenders faster turnaround on reimbursements for services.  Success in these areas requires efficient processes and effective supporting systems.  Quality Healthcare Partners (Quality) specializes in enhancing our clients’ efficiency of operations, quality of patient care, and bottom-line performance.  We are uniquely qualified to help you improve your revenue cycle operations.

Quality’s Revenue Cycle Optimization Offerings

Quality can provide consultants who are experienced in revenue cycle operations and are equipped with the tools and analytical skills needed to conduct a multi-factorial assessment of your revenue cycle.  The work is performed largely on-site with Quality consultants performing observations and data gathering.  Quality will identify and assess the procedures at the front-end, mid-cycle, and back-end processing points.  At the front-end, Quality will analyze authorization, scheduling, patient access, service collection, and other related areas.  Mid-cycle processes analysis will include charge capture, clinical documentation, transcription, HIM, coding and billing.  Back-end analysis will focus on such processes as Patient Financial Services, collections, analytics, A/R management, and payer follow-up.

Quality will deliver an assessment report detailing its recommendations for revenue cycle improvements.  The report will specify a plan of action to guide the client in making the corrective changes.  It will also quantify the types of benefits to be expected.

Quality’s Credentials and Client Experiences

Quality’s revenue integrity specialists have years of successful healthcare management experience working for acute care hospitals, clinics, and physician practices. They also possess operational experienced in revenue cycle management, patient access, charge capture, charge master integration, medical chart auditing, and reimbursement optimization.

Project examples include:

  • Created and updated corporate policy and procedures for revenue cycle departments
  • Standardized workflow for revenue charge capture and charge audit
  • Documented charge capture workflows and created proactive approaches to prevent revenue leakage
  • Consolidated OR procedures across multiple hospitals for corporate releveling
  • Validated new hospital charges for acquired hospital to optimize revenue capture
  • Implementing EPIC, Oracle Health/Cerner, QuadraMed hospital and professional billing systems

Benefits to Your Organization

  • Revenue increases by eliminating areas of leakage
  • Reduction in AR, DNFB shrinks because root cause solutions are implemented
  • Reductions in line-item claim denials by fixing the causes before billing
  • Improved financial results and increases in cash for use in operations and capital expenditures