Revenue Cycle Assessment

Heathcare Revenue Cycle Assessment Services

Every healthcare organization has hidden sources of lost revenue. Our comprehensive RCM assessment audit uncovers them so you can regain what's rightfully yours.

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Discover Opportunities for Revenue Growth

Pinpoint Revenue Leaks and Lost Funds

We'll dive deep into your revenue cycle data. We'll reveal areas that are underperforming. Money was left from coding errors, missed charges, and underpayments.

Detect subtle revenue leaks
Expose underperforming areas
Initiate recovery of lost funds

Reduce Claim Denials and Improve Reimbursement

Our analysis finds the root causes of claim denials. We can then recommend specific process changes. These changes will boost reimbursement rates and speed up cash flow.

We have proven methods and healthcare expertise. We'll find at least one clear opportunity within 21 days. Or, we'll refund your assessment fee.

Reduce claim denial rates
Improve reimbursement strategies
Enhance claim processing accuracy

Engaging with our Revenue Recovery Solution is easy.

Common Questions about RCM Assessments

What is a revenue cycle assessment, and why is it important for my business?

How long does a typical revenue cycle assessment take, and what does the process involve?

The assessment's duration and process can vary a lot. This depends on the size and complexity of the healthcare organization. It also depends on the goals of the assessment. Generally, an assessment can take from a few weeks to several months to complete. Here's a breakdown of the typical process and timeline:

Duration

First, you have the typical first engagement with Gistia. It lasts about 21 business days. But, this may vary depending on the situation at hand and the complexity of RCM.

For small clinics, a revenue cycle assessment might take 4 to 8 weeks. The smaller volume of transactions and simpler processes can speed up the review.

Large healthcare organizations are different. They include hospitals or healthcare systems with many departments and services. The assessment for them could last from 2 to 6 months. The operations in such settings are complex and high volume. This complexity requires a more thorough and time-consuming review.

Process

Preparation and Planning: This phase has 3 parts. First, we define the scope and goals of the assessment. Then, we form the assessment team. Finally, we plan the assessment process. It includes collecting preliminary data and scheduling interviews with key personnel.
Data Collection: In this phase, detailed financial data, policies, procedures, and system reports are collected. This might include claims data, accounts receivable (A/R) reports, denial data, and more.
Stakeholder Interviews: We interviewe staff from various departments (billing, coding, patient access, etc.). They help us find the challenges. They see inefficiencies in the revenue cycle.
Process Review and Mapping: The assessment team reviews and maps existing revenue cycle processes. These processes go from patient registration to final payment posting. This helps identify bottlenecks, redundancies, and areas lacking control.
Technology Evaluation: The team evaluates the technology and tools in use. This includes the Electronic Health Record (EHR) system. It also includes billing software and other technology that supports revenue cycle.
Analysis and Findings: We analyze the collected data and information. We do this to find trends, issues, and ways to improve. This analysis focuses on key performance indicators (KPIs). These include clean claim rates, denial rates, and days in A/R.
Recommendations: Based on the findings, the team makes a set of recommendations. The aim is to fix the identified issues and improve the revenue cycle. These recommendations are prioritized based on their expected impact and feasibility.
Report Preparation and Presentation: We prepare a full report. It summarizes the findings, analysis, and recommendations. We present it to the organization's leadership. This report is the basis for making an action plan. The plan will implement the recommended changes.
Implementation Planning: The final phase involves planning. It will implement the assessment's recommendations. These may include process changes, staff training, new policies, and better technology.

What are the potential benefits of implementing recommendations from a revenue cycle assessment?

Following assessment recommendations can transform a healthcare organization. The changes can bring many benefits. They will affect operations, finances, and patient experience. Here are some of the key benefits:

Enhanced Revenue and Reduced Leakage

One of the primary benefits is an increase in captured revenue. They can boost their profits by finding and fixing places where revenue is leaking. This can include undercoding, missed charges, or uncollected patient payments.

Improved Cash Flow:

Recommendations often lead to faster claim submissions. They also reduce days in accounts receivable (A/R). This billing and collections improvement boosts cash flow. It provides more predictable revenue.

Decreased Denial Rates:

A thorough assessment uncovers common causes of claim denials. These include coding errors and insufficient documentation. Fixing these issues cuts the current denial rate. It also sets up processes to stop future denials. This saves the time and resources spent on appeals and rework.

Operational Efficiency:

Implementing process improvements can lead to greater operational efficiency. Streamlining patient registration, billing, and coding cuts redundancies. It reduces manual effort and can lower the need for more staff. This lowers operational costs.

Compliance Enhancement:

A revenue cycle assessment gives recommendations. They often include ways to improve compliance with coding and billing rules. This reduces the risk of audits and penalties from regulators. It ensures that the organization's practices follow industry standards and laws.

Technology Optimization:

Many assessments suggest ways to better utilize existing technology or recommend new solutions. Using Electronic Health Records and RCM software can improve billing. So can patient engagement tools. They also improve patient communications and overall operations.

Data-Driven Decision Making:

Implementing assessment recommendations often involves improving data capture and reporting capabilities. Better data helps healthcare organizations make informed decisions. These decisions are about operations and strategy. They lead to lasting improvement and growth.

Increased Patient Satisfaction:

Streamlining billing and improving financial communication can enhance the patient experience. Clear, accurate billing and quick billing inquiry resolution raise patient satisfaction and loyalty. These are crucial today in healthcare's competitive environment.

Strategic Financial Planning:

Better revenue cycle performance helps healthcare organizations. They can plan more strategically for the future. This may include adding services and investing in new tech. It also means pursuing other growth plans confidently. The foundation is solid.

Staff Satisfaction and Morale:

The assessment's recommendations can lead to higher job satisfaction and morale. They do this by fixing workflow problems and cutting admin work for staff. When staff are less held back by bad processes, they can focus more on patient care. They can also focus on other fulfilling parts of their roles.

Next Steps: Book a Strategy Call

We'll get on a quick call with you and help you determine if we're a good fit, and if we might be able to help you.

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Senior IT Director at Avero

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Senior Director of Business Operations - Payor Relations at Gravity Diagnostics

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Chief Technology Officer at LynxDx