Revenue Cycle Management
With the shift from volume to value, the financial obligations of running a hospital are increasingly driven by quality of care and patient experience. Some of the same success indicators that help you get reimbursed can also demonstrate your hospital’s performance by way of patient quality scores.
Prism’s revenue cycle consultants have decades of experience working with hospitals, health systems, and academic medical centers in every aspect of revenue cycle management, from patient scheduling and pre-registration to denials management and underpayment recoveries, plus everything in between. Our revenue cycle expertise will drive the implementation of sustainable process improvements across the revenue cycle.
A high-functioning healthcare organization now depends on having the right data in the right place at the right time. By going beyond standard benchmarking, we help organizations increase their reimbursement and reputation by building upon the hard work and culture already in place.
Here is a sample of areas where Prism’s revenue cycle team can help you find opportunities:
- Revenue Cycle Strategy and Operating Model. Successful revenue cycle strategy embraces patient satisfaction, revenue maximization, and expedited cash flow in a low-cost and efficient collection model. Prism is expert in enhancing the patient experience in net revenue focused initiatives throughout the revenue cycle. From easy patient access incorporated into effective financial clearance, to the deployment of leading collections technology, our consultants work with clients to build a customized, comprehensive revenue cycle operating model. Our revenue cycle team helps hospitals align internal and external capabilities to maximize cash flow at the lowest operating cost.
- Medicaid Eligibility. We often find that our clients convert only a fraction of self-pay patients eligible for Medicaid, leading to an unnecessarily large amount of uncollectable bad debt. Prism can help you refine your scheduling process, identify patients earlier who might qualify for financial assistance, and improve financial counseling.
- Patient Scheduling and Financial Clearance. We help clients reduce denials and underpayments by standardizing and, when appropriate, centralizing scheduling, pre-registration, registration, and insurance verification processes.
- Strategic Pricing. Because of the shift in payment patterns, we see hospitals charging too little to qualify for market-adjusted reimbursement. We’ll show you which price adjustments make the most sense.
- Cash Acceleration. Changes in the healthcare environment create an urgent need for cash at hospital and health systems. Prism’s proven cash acceleration methodology helps clients quickly liquidate aging accounts receivables into cash.
- Billing and Collections. Patients are assuming more overall financial responsibility than they used to, and that means hospitals must communicate costs as early as possible. An efficient and transparent billing process helps both staff and patients, facilitates smoother follow-up, and improves accounts receivable management. Our solutions help reduce overall cost-to-collect.
- Denials Management. Payor contracts and relationships are becoming increasingly complex. As notification and billing requirements change, so should your denials management strategies. We implement sustainable denials prevention and resolution strategies for both that support recurring net revenue benefit.
- Clinical Documentation Improvement. The ability to capture the complexity of care required by patients continues to be a challenge in many organizations. Prism’s Clinical Documentation Improvement team can teach your coders, clinical documentation specialists, and medical staff to collaborate to deliver an accurate and complete medical record for each patient. We will work with your team to enhance charge capture and accurately reflect indicators, such as risk of mortality and severity of illness, so that you can bill accurately and receive due credit for the care delivered.
- Health Information Management. Ensuring the accuracy, availability, and protection of clinical information is essential in the delivery of healthcare services and healthcare-related decisions. Prism’s Health Information Management team helps hospitals develop and implement organizational best practices related to policies, procedures, and standards governing patient health information, resulting in maximum reimbursement, improved compliance, and elevated safety and quality scores.
- Vendor Contracts. Whether it’s a managed care contract or financial services agreements with vendors, Prism can help you negotiate the most favorable prices and terms for your organization. We bring experience in a variety of areas including technology, outsourcing, and other revenue cycle vendors.
- Cerner/Soarian/Epic Optimization. Sometimes, old processes aren’t right for a new electronic health records (EHR) system. We help you optimize the functionality of your EHR technologies – before and after system conversion — so everything works together seamlessly and your clinicians can focus on patient care.
An action plan for leaders: 5 questions on hospital performance improvement amid political uncertainty
Brad Fetters and Ramona Lacy, FACHE | July 2017
Webinar | June 21, 2017
The healthcare executive’s 2-minute read on priorities for 2017: Revenue cycle and clinical documentation improvement
Laura Jacquin, RN, John Storino and Nick Petrus | June 2017
Laura Jacquin, RN and Denise Tinkel, RRT, MHA, CCDS | October 2016
Government intervention: Boon or burden for healthcare? CNN’s David Gregory and executives from Banner, Northwestern, Prism weigh in
Becker’s Hospital Review | May 2016
Mukesh Gangwal and George Whetsell, FACHE | July 2015