Revenue Cycle Management (RCM)

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Patient Financial Experience:

Educating your patients as it relates to the "Value Proposition" of being more involved in their care is key to enhancing the patient financial experience.  Another area of potential improvemetn in this area of helping financially indigent patients with their co-insurance challenges.  We train your staff on many of the ways to change patient behaviors in this challenging area.

Improving Clinical Documentation:

Clinical documentation is one of the most challenging areas of improvement required for a successful VBS program implementation.  We have built multiple training tools to help your staff get the training they need for CDI.

Claim Processing:

The Chronic Care Management has many new CPT codes to bill (potentially monthly).  Should you enroll 1,000 patients in your new VBC program, you could bill over 2,500 separate claims per month as follows:

• CCM - 20 minutes (up to 90 for some patients)
• RPM - Device and Education
• TCM - Hospital Discharge
• Obesity, Depression, Smoking Cessation and Preventative Care Services)

Lastly, the biggest challenge is having enough properly trained staff to manage all of these new claims and to potentially build an "Automated Charge Entry" function for your RCM department to automate the billing of these claims.

Denial Management & Co-Insurance:

In theory, if the staff is properly trained this area of RCM will be limited as we will show your team how to submit the vast majority of their claims as "Clean Claims" and not have a large number of denials.  There is also more good news.... Co-Insurance for most of these claim types has been waived by Medicare, with even more CPT codes in this category to have co-insurance waived in 2021.

Revenue Cycle Management (coding, billing and reimbursement activities) is fairly complex in this area of healthcare.  One of the common reactions from RCM staff is how much additional work is involved to implement these programs.  We can show you how to automate many of the activities, while simultaneously optimizing compliance with Medicare regulations.

We have developed robust RCM spreadsheet tools for use by your Health System or Medical Group so as to allow your organization to see the economic opportunities available to you.  Then we use other tools to help optimize overall implementation on an on-going basis for the program which measures staff utilization and patient retention.