Revenue Cycle
Services

Revenue Cycle
Services

Overview


Running a hospital or health system in today’s environment is extremely challenging and requires excellence in many critical areas. Maintaining last year’s performance is frequently not enough. We help our clients to challenge their historical practices and implement new processes to enable higher levels of performance.

One of the central challenges all hospitals and health systems face is how to provide world-class care while managing their scarce resources.

We are working with our clients to improve their revenue cycle functions.

To thrive in the current healthcare environment requires successfully managing all aspects of your revenue cycle.

Revenue Cycle Services

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Revenue Assessment & Planning

Point of Service Collections

Denials Management

Charge Capture

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Supply Standardization

Charge Description Master (“CDM”) Optimization

CDM & Charging Integration Services

Charging & Coding Validations

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EMR Go-Live Billing Integrity

Observation Management

Care Management Improvement

Revenue Optimization

Accounts Receivable Management

Revenue Assessment & Planning


A high functioning central business office is required for hospitals to realize reimbursement for the high-quality care provided to their patient population. If not properly managed, vendor utilization, aged accounts receivable, insurance follow up, and billing processes will negatively impact the hospital’s financial position. Our team at Claro Healthcare assists in evaluating the processes, staffing, and key metrics related to the CBO to ensure optimal and timely revenue realization. 

Point of Service Collections


Collecting patient copays and coinsurance at the point of service is an integral part of the registration process. If not properly calculated and quantified, patient liability payments are often delayed and can result in increased write-offs downstream. Claro Healthcare evaluates staffing levels and training in addition to the processes related to point of service collections to calculate payments based on patient insurance information and services provided.

Denials Management


Hospitals and health systems are facing increased scrutiny from payors for the services provided to their patient populations and are often seeing increased denials as a result. Our team has the deep industry experience to assess existing processes for preventing and managing denials including conducting root cause analyses, evaluating medical necessity documentation in the EMR, and providing education to clinical and non-clinical staff from the front to back end of the revenue cycle.

Charge Capture


Accurate and complete capture of charges for the services rendered is a critical element for providers to properly reflect patient acuity, resource consumption, and cost of care. Our team understands the numerous complexities and details involved to get it right. Our services and approach include a combination of people, process, and technology for long-term sustainable results.

Supply Standardization


As health systems continue to grow and expand, there are many challenges associated with integrating varying approaches on charging supplies across thousands of low cost and high-cost supplies. A consistent supply charging policy can be very challenging to attain across facilities due to these varying approaches, commercial/managed care contracts, mark-up methodologies, and differing financial implications. Our team has the deep experience, approach, and resources to implement consistent methodologies while balancing market sensitivities and financial impact.

Charge Description Master Optimization


The Charge Description Master (“CDM”) serves as the foundation for reflecting the services provided, the resources consumed, and for appropriate reimbursement. An accurate and complete CDM requires effective collaboration across numerous stakeholders blending the knowledge of clinical, finance, compliance, and information systems. Our team assists with evaluating and updating the CDM for completeness and accuracy, including the related processes and systems for appropriate reflection of services and the associated reimbursement.

CDM & Charging Integration Services


Integrating the CDM and charging methodologies and practices across an expanding health system with varying patient mix, service mix, and payer contracts is a multi-faceted challenge faced in today’s healthcare environment. Our team has the deep experience and methodologies to integrate varying practices for a consistent approach while balancing market sensitivities and financial impact.

Charging & Coding Validations


Accurate charging and coding for the services rendered requires a combination of effective people, process, and technology. Our team conducts detailed coding and charging validation services to evaluate existing performance, identify areas of opportunity, and create improvement plans to address this key element of the revenue cycle.

Working together to help support your central revenue cycle functions.

EMR Go-Live Billing Integrity


As health systems integrate onto a common EMR platform, it is of great importance to facilitate an effective transition that allows revenue to quickly and accurately return to expected levels. Our team has extensive knowledge of these conversions. As the Go-Live occurs, our team performs a pre-bill claim review across higher risk services lines to review for accuracy in charges and billing prior to thousands of claims being sent to payers.

Observation Management


Optimizing the patient status determination process and minimizing observation patient length of stay is an increasingly complicated process for hospitals. Since the implementation of the two-midnight rule by CMS, hospitals have struggled with climbing observation rates. With inpatient payment levels being significantly greater than payments for an observation stay, more appropriate conversions to inpatient status can result in significant benefit for a hospital system.

Care Management Improvement


Ensuring the effectiveness of the Care Management role including care coordination, utilization management, case management, and social work is important in today’s healthcare environment. We help our clients bridge patient care and performance improvement needs.

Revenue Optimization


Effectively converting claims into revenue for a hospital requires the coordination of a number of functions across the entire revenue cycle. Even small issues related to a particular department can have larger consequences downstream resulting in reduced collections, increased days in AR, and costly write-offs for the organization. Our team assesses the revenue cycle from start to finish in order to ensure all cash is collected appropriately. Our evaluation focuses on ensuring all processes related to billing, AR follow up, and underpayments are optimized so that clean claims are submitted and paid timely and correctly.

Accounts Receivable Management


Managing accounts receivable is critical for hospitals to maintain a strong balance sheet and ensure timely revenue realization. Claro Healthcare assists our clients in effectively managing their AR through evaluation of follow up processes, staffing, and automation.

We look forward to working with you.

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