Revenue Enhancement Strategies Services
Analysis includes an assessment of current write-off practices, denial tracking procedures, root cause analysis, the corrective action feedback loop, monitoring mechanisms and appeal processing. The analysis is accomplished through a review of denial reports, review of appeal documentation, review of current remittance advices and interviews with the revenue cycle teams. Revenue Enhancement Strategies, Inc. can assist your hospital in creating a denials database and develop the appropriate infrastructure to perform root cause analysis to correct the issue at its source. We will help your staff develop strategies to appeal denials and recover reimbursement on denied claims.
A full review of contract management polices and procedures will be performed including claim and payment interface reconciliation, variance analysis, recovery and follow-up. An analysis of variances identified against our database of local payer underpayment issues. We will help your staff develop and implement best practice policies and procedures. A full analysis of staffing skills and levels as well as underpayment recovery results will be completed.
Revenue Enhancement Strategies, Inc. will perform an analysis in all clinical areas to assure that all services and supplies are charged, coded and billed properly. This assessment includes meeting with clinical staff to review services provided, encounter form review, code assignment, charge entry procedures, patient/charge reconciliation procedures, and daily reconciliation procedures.
A review of coded cases will be completed against billing data sent to the payers. Issues will be identified and quantified. Source of deficiencies in documentation, coding or systems will be identified. Corrective actions will be recommended. Recoveries will be completed based on payer’s filing deadlines.
Revenue Enhancement Strategies, Inc. will assure that all charge data is accurate with respect to payer specific CPT, HCPCS and revenue codes. We will test the billing data flow to assure that internal rejection reports are “turned on” and are reconciled daily to the A/R system. We will review all master dictionaries that impact billing such as doctor master codes (i.e. UPIN’s, payer specific provider numbers), disposition codes and credentialing. We will also review compliance with payer specific claim form logic.
Revenue Enhancement Strategies, Inc. will focus a review on the Pharmacy, Nuclear Medicine, Radiology, Operating Rooms, Nuclear Medicine, Cardiology Procedure Areas, as well as other clinical areas with a high level of billing complexity. Recommended changes will be implemented. Lost revenue will be recovered. Policies and procedures for on-going CDM maintenance will be provided.
The process for assuring a claim has paid correctly and fully will be assessed. This includes a review of the identification, feedback and resolution of the under and over payment variances, either with or without the use of a contract management system. Procedures will be developed to assure all revenue associated with underpayments is collected in full. Revenue identified as “lost” will be recovered within payer allowable time limits.
An assessment will be made to test billing controls:
- Missing charges
- Late charges
- DNFB – monitoring key thresholds
- Claim submission controls (scrubber reports)
Revenue Enhancement Strategies, Inc. will write reports that aggregate data related to claims suspended in Medicare locations. We will trend issues and help your institution take corrective actions to resolve pended claims and prevent future rejections. Revenue Enhancement Strategies, Inc. has developed a tool to address the cause of each error code and a corrective action step to resolve the pended claim.
Revenue Enhancement Strategies, Inc. will document and evaluate your current Revenue Cycle systems environment. Issues identified will be documented and recommendations will be made on system corrections or enhancements that will have a positive impact on reimbursement.
Contract analysis will consist of a high level review of Hospital’s HMO contracts. Revenue Enhancement Strategies, Inc. will identify vague language and/or terms that may contribute to underpayment of non-payment for services. We will make specific recommendations that provide for carve-outs and/or add-on payments based upon the findings of our review.
Revenue Enhancement Strategies, Inc. will perform casemix analysis and coding validation. We will review your current practice of evaluating the DRG validation process and make recommendations on coding and documentation practice that impact reimbursement.
