| |
| |
Revenue Cycle Enhancement
As healthcare payor reimbursement processes become more complicated, collecting revenue already
earned by physicians has become an increasingly difficult challenge. In addition to the demands of
making certain that insurance and patient service information is accurately collected and billed, greater
demands have been placed on billing professionals and offices due to coding complexity increases,
adherence to compliance regulations, HIPAA requirements, challenges presented by clinical trials billing,
and the explosion of integrated practice management systems. Small errors at any step of the revenue cycle
process can cascade into lost revenue, greater cost of collections, and liability. As a result of these
challenges, many providers are experiencing a rising cost of collections while at the same time experiencing
a decrease in percentage of fees collected.
ECG assists physicians in collecting a greater portion of the funds they are already owed. Every
aspect of the revenue cycle, from the first patient contact to payor follow-up, is essential to successful
collections; we therefore work with clients on all facets of the problem, including scheduling, registration,
charge capture, billing, and collections. We help clients to review their current operations and
organizational structure, measuring performance and staffing levels against industry standards and identifying
areas for improvement. We also help clients to implement those improvements and develop ongoing performance
metrics so that revenue cycle improvement can become an ongoing process. As a result, our clients receive
quick, tangible results – you collect more cash sooner with a reduced cost of collections, not just once,
but on an ongoing basis.
In addition, our experience at the intersection of hospitals and physicians allows us to understand
the challenges to front-end revenue cycle integration that is necessary in integrated health systems, academic
medical centers, and service line-based programs. We work with clients to streamline the front-end process for
patients while ensuring smooth integration with the revenue cycle.
For our clients engaged in clinical trials billing, we have consultants that dedicate their
professional efforts to understanding and solving the unique challenges of ensuring that appropriate
standard-of-care billing is made to payors, while non-standard–of-care services are billed to the research grant.
Unlike many consulting firms, ECG does not structure the
engagement so that our consultants staff your revenue cycle
office. Our goal is for our professional consultants to
identify the issues, then train and equip your billing
professionals with the understanding, tools, and abilities to address these issues on an
ongoing basis. When we leave the client site, the performance improvements do not go with us; they remain with
your billing professionals.
The following are examples of our work and the clients’ results:
|
|
| |
 |
|
 |
Selected Projects
- Revenue cycle business model development and implementation.
ECG assisted a large, highly decentralized,
multi-specialty academic practice plan in the assessment of alternative revenue cycle business models to enhance
collections, patient satisfaction, and control costs. We facilitated the development of consensus among the
clinical departments during the evaluation and selection of the optimum model and developed a business plan for
the implementation and ongoing operation of the new hybrid revenue cycle model. We then assisted in the implementation
of the new model for a pilot group of departments. The practice plan has successfully implemented the new model for all
planned departments, achieved collection expectations, maintained department autonomy where appropriate, and added common
operations/systems where needed to achieve performance expectations and control costs.
- Revenue cycle assessment and collection improvement.
ECG conducted a revenue cycle assessment of large,
centralized, multi-specialty practice plan whose leadership was concerned about overall collection performance.
The assessment included analyzing financial trends compared to benchmarks, reviewing back-end operations, and
evaluating the organizational structure, staffing levels, and management practices. In addition, we developed a
set of specific recommendations to improve operations, reduce days in accounts receivable, and increase collections.
We oversaw the implementation of our recommendations and that resulted in obtaining our estimated collection targets.
- Interim management of the revenue cycle operations.
Physician leadership at a large academic practice
plan was concerned about revenue cycle performance and this concern in part led to the director leaving. ECG was
engaged to provide an interim manager for the revenue cycle organization, stabilize the situation from the staffs’
perspective, develop a collection enhancement plan, and execute the collection enhancement plan. We successfully
addressed each of these project objectives to the point where our interim manager was offered the director’s position.
- Practice management system acquisition.
We have assisted numerous centralized and
decentralized practice plans in the
selection process for the practice
management system. The selection process
typically includes a requirements analysis,
development of a Request for Proposal (RFP),
development of an evaluation strategy and
detailed model, facilitation of executing
the evaluation model, and participation
in/leading of contract negotiations. Our
system acquisition engagements have covered
the spectrum from simple and quick Request for Quotation processes involving a few prequalified vendors, to elaborate RFPs that
address state procurement rules and regulations as well as needs of both the practice plan and hospital.
- Patient accounting system implementation.
ECG have assisted both centralized and decentralized
practice plans in the implementation of the practice management system. Our role typically involves developing the
implementation plan and organizational structure, conducting project management of the system implementation or
assisting the client project manager with the implementation, and developing key deliverables, such as the ongoing
risk assessment document, testing plans, and go-live strategy. We take great pride in the fact that all of our
system implementations have been successful and our clients’ expected collections have never been negatively impacted
by the system implementation.
- Diagnostic revenue cycle assessment of a decentralized practice plan.
We conducted a revenue cycle assessment for a large,
decentralized school of medicine. The assessment included the centralized components of the revenue cycle (information
systems, self-pay collections, etc.) and the revenue cycle components conducted in six preselected departments (e.g.,
patient scheduling, patient check-in/checkout, insurance billing and collection). The outcome of the project was a set
of recommendations that enhanced both the centralized and decentralized components of the revenue cycle. The results of
the project were so well received that we were asked by other departments to conduct the assessment for them.
- Clinical trials billing audit and improvement.
ECG assisted a large, multihospital, independent
academic medical center to conduct an audit of the clinical trials billing function across the organization. We performed
a complete audit of the clinical trials billing process and a random audit of selected accounts. The engagement resulted
in recommendations to: (1) enhance account setup in order to clearly delineate standard-of-care versus research activities;
(2) revise the billing process to ensure accurate and complete billing to the sponsor, payor, and patient (where applicable);
(3) conduct regular random audits of patient accounts; and (4) enhance and standardize the sponsor negotiation and contracting
functions. The results of our project included a more standardized and clear clinical trials billing function, a process that
fosters complete compliance, and improved financial performance.
|
|
|
Related
Links
|
 |
|
 |
| |
|
|
|
|
Home
Site Map
Contact Us
Search
