Revenue Cycle Management
The whole cycle, from patient scheduling to the final payment.
Revenue cycle management covers eligibility, charge capture, coding review, submission, posting, denial resolution and the reporting that ties them together. We manage it as one process rather than a set of disconnected tasks, because the failures usually happen where one step hands off to the next.
Tools we work in
- athenahealth
- eClinicalWorks
- NextGen
- AdvancedMD
- Availity
- Waystar
- Change Healthcare
Works well with
Scope
What this covers
The specific work included when you engage us for this service.
- Front-end verification of eligibility, benefits and coordination of benefits
- Charge capture review against the clinical documentation before anything is billed
- Coding review and claim scrubbing prior to submission
- Submission, acknowledgement tracking and timely-filing monitoring
- Payment posting, reconciliation and underpayment review against contract terms
- Denial prevention work built from the causes that actually repeat for your payers
- Patient responsibility estimation, so cost is discussed before the visit rather than after
What you receive
- 01A revenue cycle process map showing each handoff and who owns it
- 02Monthly reporting by payer covering charges, collections, adjustments and denial reasons
- 03A short list of the recurring causes behind most of your denials, with a fix attached to each
Questions
Revenue Cycle Management, answered
Which part of the cycle causes the most lost revenue?
In our experience it is rarely one dramatic failure. It is a cluster of small, repeating ones: an authorisation that expired before the visit, a payer that changed a policy and nobody updated the workflow, a modifier left off, a claim that sat waiting on a document until it passed timely filing. Each is trivial alone and expensive in aggregate, which is why we start by measuring them rather than assuming we know the culprit.
Do you work on a percentage of collections?
Some practices prefer that structure and it is a normal model in this industry. We will agree whatever fits the scope before starting. What we will not do is take a percentage of collections and then decline to measure the result, the reporting is the same either way, and it should show what changed and what did not.
What do you need from us to begin?
Read access to the practice management system or a regular reporting extract, your payer contracts, and one named person on your side who can answer clinical and coding questions. That last item matters more than it sounds: without a clinical contact, any claim that needs documentation clarification will sit unresolved while everyone waits for someone else to decide.
Most often requested by
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Working denials by cause, inside the payer's deadline.
Prior Authorization
Keeping authorisations valid from the order to the date of service.
Tell us where the manual work is
A 30-minute call. We map the process, tell you what we would automate or build first, and what it costs. No retainer before you agree the scope.
- No retainer before scope is agreed
- Written plan you can act on alone
- Worldwide delivery, on your hours