FIND THE PATH TO HEALTHY REVENUE
Developed by: Gene Howell, CEO & Co-Founder InsightRCM
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If you’re seeing a longer A/R story than you’d like, repeated claim denials, have a growing pile of appeals, or find yourself downcoding some services because you’re unclear about the necessary documentation, then you will benefit from expert Revenue Cycle Management (RCM).
A great revenue cycle starts with confident documentation from an EHR that guides visits to the most appropriate E&M level. Chart analysis by Urgent Care and Occupational Medicine experts ensures accurate industry coding. Taking processing out of your office streamlines your operations and puts the whole system into the hands of revenue experts that guarantee your compliance.
IMPROVE REVENUE FLOW & COMPLIANCE w/ RCM
REVENUE CYCLE MANAGEMENT
End-to-end systematic approach
Optimize earned revenue, documentation efficiency, & compliance
Complete, EHR driven documentation
A full service solution that incorporates best practices for workflow, coding, chart analysis, billing, claims processing, payment, appeals, and collections. It’s a comprehensive solution that begins with driving providers through visits that attain the strongest, appropriate levels.
WHAT’S A CPC?
Gold standard for medical coders
Trained to analyze UC/OM medical charts
Experts in ICD-9, ICD-10, CPT-4, & HCPCS codes
Able to update & correct codes in a patient chart
FIVE BEST PRACTICES 1
Specialty CPCs (certified professional coders)—drive best revenue opportunities with proper documentation.
2
Ensure EHR workflow leads providers through the right clinical documentation, like Agility’s PACErs—capture accurate and complete supporting documentation automatically.
3
Use electronic billing to reduce days in A/R—increase cash flow.
4
Automate appeals management—ensure there’s no money left on the table.
5
Continuously monitor to ensure that documentation meets medical justification and necessity (including regulatory compliance)
USE A SPECIALIST Urgent Care or Workers Compensation services aren’t the same as family practice. Why would you use the same coder?
#1
Not all CPCs are the same. For your specialized medical facility you need specialized revenue cycle knowledge. It’s imperative to your financial success that you’re billing the most appropriate types of work for each visit.
What’s gained from an expert CPC? Command of the intricacies of UC/OM coding, billing, and claims processing An expert trained to read and analyze UC/OM medical charts and strategically advise on billing codes supported by treatment documentation Constant monitoring of UC/OM industry news means they know changing regulations and carrier denial patters. Use this knowledge to minimize impact at your facility Did you know: an industry expert CPC find gaps where you’re not billing or correct coding behavior that’s not compliant
SUPERCHARGED EHR “Technology is the new workforce multiplier.”
- Pricewaterhouse Coopers, Top 10 Healthcare Issues for 2014
#2
An EHR with guided workflow is the best tool you have to ensure the complete supporting clinical documentation to drive the highest appropriate level attainment at each patient visit. Don’t spend extra time hunting for functions, buttons, or fields. Eliminate the stress of guessing how to raise E&M levels . Ensure your EHR has embedded guides that lead you right to orders. Providers reclaim the most time in their day by following an automated workflow that confidently provides full supporting documentation Best-in-class UC/OM software understands the impact of both visit level and coding-billing, and will guide documentation to drive both revenue and compliance Did you know: A powerful EHR will have a dashboard that lets you check the E&M level of your visit, instantly
ELECTRONIC BILLING Take advantage of electronic billing to shorten your billing cycle and drive increased monthly cash flow.
#3
Electronic billing can be a huge leap in efficiency for your facility—especially if you have appropriate automation processes established. Insist on electronic submissions. Don’t rely on a human brain to remember to do it or process it. Integrate information about standard charges and revised fee schedules as soon as you know there’s a change—keep the system flowing accurately Use software automation to bill encounters accurately. For OM client (employer) work, automate periodic statements (weekly, monthly, quarterly) for your billing cycle Did you know: full chart notes must be attached to Workers Compensation billing?
AUTOMATE APPEALS MANAGEMENT Data shows that 65% of claims are never appealed. That means 10-20% of your money could be left on the table.
#4
Know when you can’t avoid appeals, strictly based on payer behavior. Minimize appeals, but automate the submissions process when they’re needed, minimizing days to revenue. The best RCM services get it right the first time.
RCM strategies are focused on limiting the need for appeals through appropriate supporting documentation But, appeals are necessary! The Net Health RCM Solutions secures payment in 70% of appeals. Payers regularly alter their patterns of denials that cause common appeals—a UC/OM expert RCM service is up to date on this information to keep appeals to a minimum Did you know: Some states allow only one appeal. Others charge for a second appeal. It’s critical to get it right the first time!
MONITOR FOR CHANGES It’s a specialized industry. Changes are always afoot that will directly impact reimbursement, compliance, and the success of your business.
#5
Consider the team in your back office. Do they have time to step out of that role to educate themselves on the broader picture of the industry? Regularly? There’s a lot to know. Specialized CPCs, working with your RCM service, bring this timely, actionable information to your facility. Experts are aware of payer changes in advance and can alter your billing tactics to accommodate Invaluable experience teaches you the tricks of the trade related to UC/OM billing (like proper coding patterns for specific medications) Did you know: expert CPCs drive efficiency in your DME orders— stock the most reimbursable and clinically effective items
REAL LIFE EXAMPLES Average Net Health RCM Solution Performance:
50% reduction in claim denials
70% success rate on appeals
Highlights of Client Results:
18%
Increase in collections per chart Workers Comp, Orthopedics, Physical Therapy, Urgent Care
16%
Increase in total collections Workers Comp, Physical Therapy, Urgent Care
8%
Increase in total collections (w/ improved compliance) Workers Comp, Orthopedics, Urgent Care, Primary Care
GET NET HEALTH RCM Consult an Agility specialist
Let us evaluate your current situation. For real evidence, let Net Health RCM experts review up to 5 charts, free.
Implement Agility Software with RCM
GET NET HEALTH RCM Consult your Agility Account Executive
Let us evaluate your current situation. For real evidence, let Net Health RCM experts review up to 5 charts, free.
Once RCM is purchased, immediate implementation and training launches enhanced workflow
LEARN MORE
800.411.6281 option 3
sales@nhsinc.com
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