MDapproach™ Solution 1: Overall Revenue Cycle Improvement

Definition: The revenue cycle includes all administrative and clinical functions that contribute to the capture, management and collection of patient service revenue.

Objective:  To access the entire revenue cycle, starting with the patient’s access into the care delivery setting, and continuing through the clinical episode, ending when all financial matters associated with the episode of care are resolved.

Timeline: Varies per site, but measured in months.

Sample Work Performed:

Deliverables:  Assessment, findings and recommendations.

Sample Client Outcome:  Hayes conducted a review of the revenue cycle for a not-for-profit organization that provided overall management for a medical group. The assessment uncovered the following issues:

• Organization moving from a managed care to a fee-for-service focus
• Underutilizing the potential of the EMR system’s ability to integrate with billing system
• Lack of clear processes for check- in and check-out of patients in clinical settings
• Need for electronic  payments with fee-for-service carriers
• Billing system dictionaries not utilized to potential
• Lack of policy and procedure updates or implementation

The client received a list of operational best practices for each of the elements of the billing cycle (patient access, scheduling, check-in, check-out, charge interfaces, claim submission, account receivable workflows and collections). They were able to make system corrections in dictionaries, modules and workflows. The client also reviewed and updated policies and procedures to include system changes and the shift in organizational focus.

Revenue Cycle Solutions:

Overall Revenue Cycle Improvement
Patient Access Improvement
Clinical Workflow Optimization
Denials Reduction
Information Systems Assessment