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Revenue Cycle Assessment

In addition to specialized billing services for various medical specialties, TriumpHealth also offers revenue cycle assessment services.

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REVENUE CYCLE ANALYTICS

Revenue Cycle Assessment

Optimal revenue cycle performance hinges on constantly monitoring key performance indicators (KPIs) and acting decisively to address issues before they significantly impact your organization. If you are like most healthcare organizations, you may decide to undergo a revenue cycle assessment when there is:

Need to proactively monitor and improve financial performance
Difficulty accessing and understanding underlying data
Management change, staffing adjustments, workflow augmentations or technology conversions and implementations

TriumpHealth has conducted numerous revenue cycle assessments, and while each assessment is different, our methodology is consistent and proven. Each focused assessment provides a comprehensive analysis of your processes, data and staff, and is specific to your business needs. Relevant data is presented for users based on responsibilities. With your data, we can:

Create and monitor revenue cycle KPIs around pre-service, point-of-service, post service, denials, etc. to provide data points needed for process and financial optimization
Create and monitor revenue cycle KPIs around pre-service, point-of-service, post service, denials, etc. to provide data points needed for process and financial optimization
Provide comparative analysis and bench marking that scores payer performance based on claim, rejections, denials, and exceptions
Identify trends by drilling down to the staff, department, and service levels to uncover insightful details
Enable the calculations of HFMA Map Keys for true peer-to-peer bench marking
Maximizing reimbursement by analyzing workﬂows and optimizing activities

Revenue Cycle

Frequently Asked Questions

What is a revenue cycle assessment in the context of healthcare, and why is it important for healthcare organizations?

A revenue cycle assessment in healthcare evaluates the financial processes and workflows involved in generating revenue, billing, and reimbursement within an organization. It is important for healthcare organizations as it helps identify inefficiencies, streamline processes, and maximize revenue generation.

What are the key components or stages typically included in a comprehensive revenue cycle assessment?

Key components of a revenue cycle assessment typically include patient registration, charge capture, claims submission, payment posting, denial management, and financial reporting. These stages encompass the entire revenue cycle management process from patient encounter to reimbursement.

How does a revenue cycle assessment help identify areas of improvement or inefficiencies within the revenue cycle management process?

A revenue cycle assessment helps identify areas of improvement or inefficiencies by analyzing key performance indicators (KPIs), identifying bottlenecks, and benchmarking against MGMA and HFMA standards. It provides insights into areas such as claim denials, reimbursement delays, and revenue leakage.

What methodologies or tools are commonly used in conducting a revenue cycle assessment, and how do they contribute to the analysis and evaluation of financial processes?

Commonly used methodologies or tools in conducting a revenue cycle assessment include data analytics, workflow mapping, and financial performance metrics review. These tools facilitate data analysis, process visualization, and performance measurement to identify areas for improvement.

What are some common challenges or issues that a revenue cycle assessment can uncover, and how can healthcare organizations address these challenges to optimize their financial performance?

Common challenges or issues that a revenue cycle assessment can uncover include billing errors, coding inaccuracies, inefficient workflows, and inadequate staff training. Healthcare organizations can address these challenges by implementing process improvements, providing staff training, adopting technology solutions, and establishing robust monitoring and auditing processes to optimize financial performance.

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Our Process

1

Data Collection and Analysis

Gather financial and operational data related to the revenue cycle, including expenses associated with billing and collections processes, claims management, denials, payment posting, coding accuracy, and reimbursement rates.

Analyze key performance indicators (KPIs) such as accounts receivable (AR) days, clean claim rate, denial rate, net collection rate, and days in accounts receivable to identify areas where costs impact revenue cycle efficiency and effectiveness.

2

Process Evaluation and Workflow Analysis

Evaluate current revenue cycle processes and workflows to identify inefficiencies, bottlenecks, and areas of potential revenue leakage that contribute to the cost of doing business.

Map out the end-to-end revenue cycle workflow, from patient registration and scheduling to claim submission and payment posting, to pinpoint areas where costs can be reduced or eliminated through streamlining and optimization.

3

Root Cause Analysis and Problem Identification

Conduct a root cause analysis to identify the underlying reasons behind revenue cycle challenges that drive up the cost of doing business, such as coding errors, claim denials, payer issues, or operational inefficiencies.

Prioritize identified problems based on their impact on revenue and financial performance, focusing on high-impact areas for immediate cost-saving measures.

4

Recommendations and Action Plan

Develop recommendations and an action plan based on the findings of the assessment to address identified challenges and reduce the cost of doing business in the revenue cycle.

Prioritize action items and assign responsibilities to key stakeholders for implementation, focusing on strategies that offer the greatest potential for cost savings and efficiency gains.

Establish metrics and benchmarks to track progress and measure the effectiveness of implemented solutions over time, ensuring that cost-saving measures contribute to improved revenue cycle performance.

Provide ongoing support and monitoring to ensure successful implementation and continued reduction in the cost of doing business within the revenue cycle.

Benefits of Working with TriumpHealth

Revenue Cycle Assessment

Experienced Specialists

Benefit from a team of AAPC-certified professionals with deep industry knowledge and experience in various medical specialties.

Data-Driven Insights

Utilize our insights to identify common coding errors, undercoding, or overcoding instances, and areas for improved clinical documentation.

Tailored Recommendations

We provide actionable feedback and tailored strategies to enhance your documentation processes, maximize reimbursement, and minimize the risk of audit findings.

Staff Education

Strengthen your team’s skills with targeted education sessions based on audit findings, aimed at preventing future documentation and coding issues.

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We will help you achieve financial and regulatory compliance goals resulting in improved patient outcomes and increased revenue.