Implement Best Practices in Revenue Cycle Management

Count on our strategic revenue cycle management (RCM) professionals to rethink, reengineer, or refine the clinical, financial, and administrative functions that contribute to the capture, management, and collection of payments associated with care delivery.

We look at every step in your revenue cycle, starting as high as possible in the healthcare value chain, so no value driver is overlooked or underutilized.

Our RCM activities include but are not limited to the following.

• Review the incidence and prevalence of adverse health conditions in your community and cohort
• Reposition your organization to address the highest-value needs
• Build evidence-asset portfolios (e.g., templates for letters of medical necessity [LMNs], step therapy plans, and summaries of supporting peer-reviewed journal articles)
• Generate awareness, interest, and demand
• Schedule appointments
• Document medical/pharmacy benefit information, medical histories, and reasons for visits
• Complete patient intakes
• Manage care, take thorough SOAP notes, and create audit-ready medical records
• Diagnose patients and develop treatment plans
• Use evidence assets to secure prior authorizations, preauthorizations, or predeterminations
• Negotiate value-based coverage (VBC) and outcomes-based compensation (OBC) where applicable
• Measure real-world results (RWRs) using PROQOLID clinical outcome assessment (COA) instruments and patient-reported outcomes (PROs) surveys
• Use evidence-based coding and billing strategies
• Manage claims and denials to reduce days sales outstanding (DSO, the time span between delivery of service and receipt of payment)
• Implement a data-centric continuous improvement system (aka clinical, financial, and administrative learning system) to highlight and escalate outlier events
• Troubleshoot and eliminate practice patterns associated with unexpected failures
• Study and replicate unexpected successes

Count on us to help you improve the clinical, financial, and administrative performance, outcomes, and impacts of your organization.