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Healthcare [ Revenue Cycle ]

 

Improvement and change are difficult to incorporate into the daily operations management of hospitals and physician practices. Factors such as decreases in reimbursement (due to Medicare and Medicaid funding cuts), increases in the uninsured population, declines in margins and pressures from managed care organizations demand process improvements in the Revenue Cycle. Blue & Co. has long demonstrated improved operational results for our clients in key areas of the Revenue Cycle by providing value-added services, such as those below, that result in operational improvements to maximize the revenue and improve the cash flow at your organization.

 


When you become a client of Blue & Co., you get much more than a team of experienced consultants. You get a group of professionals thoroughly committed to a philosophy of integrity and service. It's this philosophy that makes BCS a leading provider of consulting services to the healthcare industry.


We blend the experience you expect with the attention you deserve. Unlike larger firms, you'll work with a close-knit team of directors and managers who attend to your every question, answer your calls promptly, and make sure you are at ease through each step of our work together.


BCS works hard to build both a personal and professional relationship with you so we can best understand your needs. Our clients respect us because we tell them what they need to hear — even when it's not what they want to hear. From there, we'll work with you to create the best plan for your business.


BCS exceeds your expectations by identifying areas and needs you may not even realize you have. We then create a strategy to reach your current and future goals. Our support doesn't stop there; we'll equip you with the materials, training, and understanding to help you turn your plans into reality. You might say we don't merely think, we do.


At BCS, we embrace each project with enthusiasm and dedication, and we are excited to become part of your team. We want to see you succeed, and our interest in your success is genuine. We show our clients this commitment everyday through a pledge to excellence and strong working relationships.


Hospital Accounts Receivable Assessment and Action Plan

BCS provides a complete Accounts Receivable (AR) analysis from patient access to billing, follow-up, and collection. Our analysis will in turn offer opportunities for improved productivity and cash flow, reduced days in AR, and decreased bad debt. We develop an action plan your organization can use as a tool to address our recommendations. The action plan consists of necessary steps, time frames, responsible parties, expected outcomes and key performance indicators to measure success.


Patient Access Development – Centralized Scheduling and Pre-Arrival

The healthcare industry has mandated that hospitals re-engineer their AR processes by placing greater emphasis on the initial scheduling of services. At the time services are scheduled, the hospital should ensure that the services are medically necessary and pre-authorized by the insurer(s) with applicable benefits in addition to collecting co-payments, co-insurance, and deductibles. Charity determination should also be addressed at the onset of scheduling services when the patient is in need of assistance to meet their financial responsibility.

Benchmarking

Establishing key performance indicators (KPIs) is vital to the management of the Revenue Cycle by the administrative team. KPIs can be established based on hospital experience and comparison to national and regional benchmarking data. BCS personnel understand the various healthcare systems and practices in order to assist with setting goals for achieving excellence.




Provider-Based Consulting

Today, hospitals are purchasing physician practices in record numbers. However, these practices can add a tremendous cost to the bottom line and therefore should be evaluated for provider-based status and reimbursement opportunity. BCS can assist with the federal regulatory requirements of the provider-based rules by assisting with the due-diligence and/or attestations required. In addition, we can assist with the billing implementation process for technical/facility and professional components and the development of the Chargemaster Analysis.

Chargemaster Analysis

An effective and up-to-date CDM is the cornerstone of charging compliance. Our service is performed by highly-trained consultants with a variety of clinical experience. We conduct a detailed analysis of the hospital’s CDM for completeness and accuracy. We also provide extensive education and training to the various users of the CDM. With our strong focus on education and our data-gathering approach, we have found significant charge capture and compliance opportunities during every CDM analysis we have performed. Our analysis includes a draft and final report that summarizes key findings per department along with detailed exhibits which identify all suggested line-item changes to the CDM (with regulatory citations, where applicable).

Chargemaster Remodeling

BCS has extensive experience with remodeling CDM structures while maintaining revenue (budget) neutrality. Our core services include building common (system-wide) CDMs, restructuring operating room charging mechanisms to promote greater charge capture and operational efficiency, and bundling individual supply and equipment charges into the associated procedures and room rates.




Charge Capture / Documentation Reviews

Our team of coding and clinical specialists will review a sampling of hospital and/or physician claims for coding, charge capture, and documentation compliance. We determine if the services billed are sufficiently documented in the medical record. In addition, we verify that the charges and procedure codes (CPT/HCPCS) as well as ICD-9 and/or ICD-10 diagnosis codes reported on the claim forms are consistent with documentation in the medical record. For our analysis, we also compare the hospital’s claims to both national and local Medicare guidelines. For instance, the NGS Medicare FI/Carrier has over 100 Local Coverage Determinations (LCDs) and Coverage Articles which include coding and coverage guidelines related to many procedures, drugs, and biologicals. In our experience, the majority of providers are non-compliant with these guidelines placing them at exposure for inappropriate payments and future recovery audits.

ICD-10 Implementation Strategy

ICD-10-CM and ICD-10-PCS will be the diagnosis coding systems that will affect every healthcare organization in a number of different ways. This is one of the most significant changes to our healthcare systems and processes in over a decade. The need for implementation is continually growing in importance. Most organizations have not yet begun preparing their processes for implementation. BCS is ready to assist hospitals and physician practices with the planning, analysis, training, and implementation assistance to ensure a seamless and painless transition to ICD-10.

Interim Coding Assistance

Our goal is to provide quick and flexible access to experienced, credentialed Health Information Management (HIM) coding professionals (RHIA/CCS). Let us fill the void left by unexpected staffing changes or relieve the burden of an increased workload (backlog). Depending on your needs, our services can be on-site or off-site, providing minimal disruption to your operations. In addition, we are available to provide related services including education and training for coders, interim coding management, and other coding-related assistance.

Supply / Pharmacy Revenue Cycle Management

Our consultants are well versed in the supply and pharmacy Revenue Cycle. We have assisted many hospitals with accurate pricing, coding, and billing of chargeable supplies, drugs, and biologicals. We also strive to reduce compliance risk while identifying areas of charge capture opportunity. Our experience will allow us to identify issues that many hospitals inevitably will encounter including concerns with identifying proper HCPCS code units (e.g., incorrect pharmacy multipliers), capturing all allowable supply charges, and maintaining appropriate links between the item master and chargemaster.

Corporate Integrity / Independent Review Organization

Our team of coding and clinical specialists will serve as an Independent Reviewer (IRO) under Corporate Integrity. We will review the Corporate Integrity Agreement (CIA) and identify areas which may require our assistance. We will, on an annual basis, perform the medical record review utilizing government standards, National and Local Carrier Determinations as well as other government payers medical policies based on the scope of the Corporate Integrity Agreement. We will ensure proper reporting based on the Office of the Inspector General's (OIG) guidance. We will also provide education to the organization, as necessary, based on the outcome of a CIA review performed by another organization. Keep in mind the firm which reviews the coding and documentation for a client under Corporate Integrity may not provide education.

Physician AR Analysis

Four out of five medical practices lose a significant amount of earned revenue from the services they provide. BCS can help recover lost revenue and provide an assessment of internal or external (billing service) receivable management. We review payer mix, provider productivity, site-specific data, days in AR, gross and net collections, and other critical data. Finally, we provide recommendations for improving the bottom line. We will help you manage your receivable both on-site and off-site through regular reviews and ongoing oversight.

New Practice Development

BCS has provided physician practice start-up services to a multitude of clients. From obtaining your tax identification number and articles of incorporation to assessing the ideal locations and office design to obtaining financing and the necessary licenses, permits and provider numbers — BCS will work alongside you each step of the way until your practice is fully up and running. Utilizing a group of professionals with a proven process assures you are on the fast track to recovering your investment.


Operational Practice Assessments

An operational assessment is a complete evaluation of the economy and efficiency of a physician practice. In-depth information about the practice is gathered and the practice is compared to others of its type using operational benchmarks established by practice management organizations. An operational assessment covers all business functions of a practice including: information systems; accounts receivable; document coding; reimbursement systems; human resource policies; patient care and satisfaction; and compliance with Occupational Safety and Health Administration (OSHA) and Clinical Laboratory Improvement Amendments (CLIA) regulations. The results of an assessment can provide guidance on improving physician practice operations. BCS has experienced staff that has a proven track record in analyzing medical practices and formulating a sound plan with your team to implement process improvement.

Ongoing Practice Management Services

Today, hospitals are purchasing physician practices in record numbers. However, these practices can add a tremendous cost to the bottom line and therefore should be evaluated for provider-based status and reimbursement opportunity. BCS can assist with the federal regulatory requirements of the provider-based rules by assisting with the due-diligence and/or attestations required. In addition, we can assist with the billing implementation process for technical/facility and professional components and the development of the Chargemaster Analysis.

Physician Education and Training

BCS provides expert instruction (administrative and/or clerical) for both the practitioner and staff. Our expert team of specialists will customize the training for your practice based on individual need providing the tools for successful documentation, coding, billing, collections, and compliance. Our trainers are well versed on evaluation and management, documentation challenges, ICD-10-CM and ICD-10-PCS, surgical coding among all specialties, ancillary coding and billing as well as regulatory guidance. Training can be conducted either on-site or via webinar and can be short topic driven sessions (one hour) or more in-depth topics comprising single or multiple day seminars.

Managed Care Contract Review

BCS provides managed care contract review and analysis in addition to fee schedule analysis and assistance during contract negotiations. During contract review and analysis, we will outline the key aspects of each managed care contract and review the contracts to identify contract terms, including effective dates, termination dates, stop loss claims, chargemaster limitations, carve-outs, claim filing, and payment guidelines. We will also identify unfavorable contract terms to the healthcare organization. Managed care contracts typically present reimbursement rates in plan-specific language that does not give the healthcare organization a clear understanding of the actual reimbursement rates. Our fee schedule analysis identifies the code specific reimbursement rates for each managed care contract and outlines the rates for each plan.

Provider Enrollment and Credentialing

Credentialing requirements are ever-changing. Newly established guidelines and deadlines for most carriers have made this function more time intensive and detailed. New providers, providers leaving their current practice, or providers changing their location of service will require new credentialing. Our experienced staff has established relationships with insurance carriers to expedite credentialing and re-credentialing. Our team is in constant contact with the carrier, ensuring the application was received and is in process, and inquiring of the time frame for approval of the application. We manage all aspects of this often complicated process, from obtaining the applications to completing them for submission. Timely and accurate credentialing will ensure that your healthcare organization is receiving its maximum revenue. BCS credentialing staff have decades of experience in credentialing and thus are experts at expediting the process.

Utilization Review (UR) and Appeals

Quality and efficiency of care are the healthcare provider's means of survival. Our consultants help determine the root cause of various UR-related issues, including level-of-care (LOC) denials, increased lengths-of-stay (LOS), higher re-admission rates, lagging quality indicators, etc. In addition, we perform limited and comprehensive operational assessments in order to offer ‘best practice' improvements. Our experienced consultants also assist with LOC documentation reviews, insurer appeals, implementation of process controls, and provide education to case managers and physicians on a variety of topics including InterQual and Milliman criteria.

Managed Care Underpayment Recovery

Millions of dollars in managed care underpayments remain uncollected each year due to misinterpreted contract terms, inappropriate denials, and limited resources devoted to remittance and explanation of benefit (EOB) follow-up. Our goal is to assist hospitals recover the maximum allowable contracted rates with third party payers. Our proven methodology identifies and resolves both payer and hospital operational issues limiting the maximum managed care dollar collection. We work with payers and hospital business offices to educate staff and foster successful relationships designed to improve efficiencies, assisting with timely and accurate third party reimbursement.

Clinical Documentation Improvement (CDI) Consulting

BCS’s Clinical Documentation Improvement solution significantly improves clinical documentation, ensuring that it fully and accurately reflects the severity of illness, complexity of care, and resources consumed. Our comprehensive program bridges the gap between clinicians and the coding and billing system, increasing and capturing appropriate reimbursement for services provided. Our depth of experience in documentation improvement results in more compliant documentation and improvement in third party reimbursement. We work collaboratively to design a comprehensive clinical documentation program, transfer the knowledge needed to achieve organizational goals, and provide follow-up services to ensure sustainability.