Revenue Cycle Solutions

Revenue Cycle Solutions

Opportunity

It is imperative for today’s healthcare providers to maximize the revenue received for the services they provide. Ineffective internal controls for key revenue cycle processes can affect net revenue by as much as 5 percent. Protiviti’s Revenue Cycle Solutions help organizations enhance revenues and margins by improving strategy, processes and system controls. Improvements include enhanced charge capture, reduced denials, identified reimbursement variances, reduced write- offs, cash acceleration, accurate charge master, increased patient satisfaction and enhanced compliance.
Protiviti has proven methodologies focused on successful, sustainable implementation of revenue cycle improvement opportunities within functions involving billing, collections, denials, cash posting and revenue integrity. Our approach is designed to improve net revenue and/or sustainable cash, accelerate cash flow, enhance overall revenue cycle performance and prepare for future acquisitions.

How We Can Help

Patient access optimization – Patient satisfaction and optimal reimbursement hinge on the efficiency and effectiveness of initial patient touch points, including patient data collection, pre- registration, insurance verification and upfront collections. Our design and implementation teams work with management to develop a roadmap for a healthy revenue cycle that mirrors the goals
of the organization, and help validate that the new patient access processes improve the overall
revenue cycle performance, increase patient satisfaction and improve net revenue.

Charge Capture and CDM – Financial success for many healthcare organizations depends directly on capturing and charging accurately for eligible services rendered and supplies used. Failures or delays in the charge capture process jeopardize revenues and patient satisfaction, as well as regulatory compliance. Charge capture process breakdowns will lead to deficiencies impacting the bottom line. Our charge capture services help organizations quantify and identify root causes of inaccurate charging and resolve them permanently. Our approach considers and balances business processes, revenue operations, technologies and compliance areas to help organizations  achieve  sustainable  improvements  and  long-term results.

ICD-10 readiness and implementation – Protiviti has expertise in assisting companies in their transition from ICD-9 to ICD-10 through strong project management methodology and extensive healthcare experience in ICD-9 revenue cycle management. Through our partnership with Jvion, we have access to RevCore – the most mature, comprehensive and granular ICD-10 financial risk assessment solution on the market. RevCore goes beyond typical DRG-level solutions to deliver detailed insights into every aspect of financial risk. This powerful tool is delivering tailored analytics for leading providers as they work to avoid ICD-10’s revenue impacts and drive a revenue neutral ICD-10 conversion.

Billing and collections – An accurate and streamlined billing process is essential to ensuring timely payment, which is why billing departments continuously work to improve both their quality assurance capabilities and their ability to process claims quickly. Protiviti can help you determine where you stack up against other billing departments and ultimately help you identify and employ the billing practices that will work best for your department. The key is to ensure you have the right monitoring and quality assurance controls in place to detect inaccuracies and pending deadlines, as well as to automate as many of these controls as  possible.

Denials/underpayments management – Protiviti will help you understand the financial impact of denials on your organization, analyze and determine the root causes of denial issues within your operations, devise strategies to minimize denials and enhance operational performance, and assist you in implementing these strategies. We offer a holistic business process approach to diagnosing and addressing denials and their consequences for your organization’s revenue operations. Our approach balances business process, compliance and technology to help you achieve long-term results and sustainable improvement. The process for ensuring payment accuracy and managing underpayments is critical to maintaining a healthy bottom line. Often, underpayments are as high as denials, especially when a contract management system is  not used to ensure actual reimbursement equals expected reimbursement. Systematically monitoring and resolving payment variances can have a significant impact on a healthcare organization’s bottom line and provide the basis for enhancing integration and communication between departments.

Regulatory compliance – Compliance can never be separated from revenue cycle improvement initiatives, and we make it a priority to ensure it is not. Protiviti has deep regulatory compliance expertise and assists with a variety of compliance audits and investigations, such as audits of payments to physicians, clinical research billing and IRB oversight, non-monetary compensation, and conflicts of interest, among many others. Protiviti also conducts compliance program effectiveness reviews that help identify and mitigate deficiencies, and has extensive HIPAA privacy and security program implementation experience.

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Susans Haseley
Susan Haseley
EVP, Global Diversity and Inclusion
+1.469.374.2435
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Richard Williams
Richard Williams
Managing Director
+1.469.374.2469
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