Consulting Services

Our Services at a Glance

Services

Discover how our comprehensive suite of RCM consulting services can transform your organization's financial health:

Revenue Cycle Assessment

Comprehensive analysis to identify strengths, weaknesses, and areas for improvement.

Evaluation of billing and coding practices, claims processing, and documentation procedures.

Patient Journey Mapping

We design and implement a streamlined billable patient journey, enhancing patient experience and financial efficiency. Our approach ensures each patient interaction is seamlessly integrated into your billing process.

Charge Master Development

Our experts develop a comprehensive charge master tailored to your services, ensuring accurate and optimized billing for every patient encounter.

Process Optimization

Streamlining RCM workflows for increased efficiency and reduced administrative burden.

Implementing best practices to minimize revenue leakage and denials.

Documentation Improvement

Review and enhancement of clinical documentation to ensure accurate coding and billing.

Training and guidance for medical staff on proper documentation practices.

Denial Management

Development of a denial management strategy to identify root causes and reduce denial rates.

Assistance in creating a proactive approach to handling claim denials and appeals.

Payer Contract Negotiation

Negotiation and renegotiation of payer contracts to ensure favorable terms and maximize reimbursements.

Analysis of fee schedules and reimbursement rates.

Coding and Billing Compliance

Auditing and validation of coding practices for compliance with industry regulations.

Implementation of compliance programs and staff training.

Technology Integration

Assessment and recommendations for RCM software and technology solutions.

Integration of electronic health records (EHR) and billing systems for seamless data exchange.

Training and Education

Customized training programs for healthcare staff on RCM best practices.

Workshops and seminars on coding, billing, and documentation guidelines.

Key Performance Indicators (KPIs) Tracking

Establishment of KPIs to monitor and measure RCM performance.

Regular reporting and analysis of KPI data for informed decision-making.

Financial Audits

Identify revenue leakage, billing errors, and areas for financial improvement.

Recommendations for corrective actions and revenue recovery.

Telehealth Billing Support

Guidance on billing and coding for telehealth services, ensuring compliance with evolving regulations.

Assistance in optimizing telehealth reimbursement processes.

Strategic Infrastructure Development

Tailoring RCM solutions to meet your needs, whether you prefer onshore or offshore strategies.

Customized Solutions

Tailored RCM solutions to address specific organizational needs and challenges.

A Guide to Creating Effective Workflows in Key RCM Areas

Creating effective workflows in key areas of Revenue Cycle Management (RCM) involves a systematic approach to optimizing and streamlining processes. Here's a guide to creating workflows in some critical RCM areas:

Patient Registration and Scheduling:
- Define the Process: Start with patient scheduling and move through to registration. Include steps for capturing patient demographics, insurance information, and reason for visit.
- Automate Appointment Reminders: Use software to send automated reminders to patients, reducing no-shows.
- Train Staff: Ensure front-desk staff are trained in patient interaction and data entry accuracy.
Insurance Verification and Authorization:
- Standardize Verification Procedures: Create a checklist for verifying insurance details, including coverage limits and co-pay amounts.
- Implement Automated Verification Tools: Use software to automate insurance eligibility checks.
- Develop a Pre-authorization Protocol: Establish steps for obtaining authorizations for specific treatments and tests.
Medical Coding and Charge Capture:
- Create a Coding Workflow: Streamline the process from service documentation to code assignment. Ensure it includes a review for accuracy.
- Regular Training: Keep coding staff updated with the latest coding changes and guidelines.
- Implement Charge Capture Technology: Use technology to ensure all services are captured and accurately billed.
Claim Submission and Management:
- Automate Claim Generation: Use EHR and billing software to generate and submit claims.
- Regular Audits: Perform regular audits to check for accuracy and compliance.
- Claim Tracking System: Implement a system for tracking claim status and follow-ups.
Denial Management:
- Create a Denial Review Process: Establish a process for reviewing and categorizing denials for further action.
- Root Cause Analysis: Analyze common denial reasons and adjust processes to prevent future denials.
- Train Staff on Resubmission and Appeal Procedures: Ensure staff are skilled in addressing and appealing denied claims.
Accounts Receivable (A/R) Management:
- A/R Tracking System: Implement a system to regularly track and follow up on outstanding A/R.
- Prioritize A/R: Develop criteria for prioritizing follow-ups, focusing on older and larger balances first.
- Regular Reporting: Set up regular reporting to monitor A/R aging and identify trends.
Payment Posting and Reconciliation:
- Automated Posting: Use software to automatically post payments to patient accounts.
- Manual Reconciliation Process: Establish a process for manually reconciling payments and adjustments.
- Daily Closing Procedures: Ensure daily closing includes reconciliation of posted payments.
Analytics and Reporting:
- Identify Key Metrics: Determine which KPIs are crucial for your organization.
- Regular Reports: Schedule regular generation of reports for analysis.
- Data-Driven Decision Making: Use insights from reports to make informed decisions about process improvements.
Patient Collections and Financial Counseling:
- Clear Communication Protocols: Establish guidelines for communicating with patients about their financial responsibilities.
- Financial Counseling Workflow: Create a process for providing financial counseling, including discussing payment options and plans.
- Collections Strategy: Develop a tiered approach for follow-up on outstanding patient balances.

For each of these areas, it’s important to document the workflow, train staff accordingly, and regularly review and adjust the processes as needed to ensure maximum efficiency and compliance.