Revenue Cycle Management Analysis

We recommended that practices review their revenue cycle management (RCM) processes at least quarterly to ensure the financial health of the practice. The key components that Prosperis Consulting includes in our revenue cycle analyses are:

• Patient Scheduling and Registration: Evaluating the efficiency and accuracy of the patient scheduling and registration process.
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• Insurance Verification and Eligibility: Assessing the process of verifying patients' insurance coverage and determining their eligibility for specific services.
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• Patient Check-in and Check-out: Examining the check-in and check-out procedures to ensure smooth patient flow and minimize wait times.
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• Coding and Documentation: Reviewing the coding and documentation practices of medical professionals to ensure accuracy and compliance with coding guidelines.
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• Claims Submission: Analyzing the process of submitting claims to insurance companies or third-party payers.
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• Accounts Receivable Management: Evaluating how the medical practice manages outstanding accounts receivable.
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• Payment Processing and Posting: Reviewing the procedures for processing payments from patients and insurance companies and accurately posting them to patient accounts.
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• Denials and Appeals Management: Assessing how the practice handles claim denials and appeals.
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• Financial Reporting and Analysis: Analyzing financial reports to understand revenue trends, identify potential issues, and make data-driven decisions to improve the revenue cycle.
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• Compliance and Regulations: Ensuring that the revenue cycle processes adhere to all relevant healthcare regulations, billing guidelines, and compliance requirements.
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• Integration of Technology: Evaluating the utilization of technology, such as revenue cycle management software and electronic health records (EHR), to streamline processes and improve efficiency.

What You Can Expect from Revenue Cycle Management Analysis

• Financial Reports and Metrics
• Accounts Receivable Aging Report
• Claim Denials and Rejections Analysis
• Revenue Trends and Patterns
• Key Performance Indicators (KPIs):
• Coding and Documentation Audit Results
• Recommendations and Action Plan