Revenue Cycle Audit and Denial Management
Hospitals & Medical PracticesDaily operations require billing and collections be the top priority of the revenue cycle management operations. Retrospective analysis and reconciliation often fall by the wayside in order to have a continuous cash flow. The lack of Revenue Cycle Audit and Denial Management can lead to cash collection reduction and costly overhead to obtain the correct payment from the payer.
Root cause denial review
Root cause identification of denials by payors and reason is needed to increase the timeliness of claims payment. Targeting the top five to ten insurance payors by revenue and denial rates can determine appeal success and future prevention of denials. The internal areas that may be involved in the issue are pre-registration, utilization review, and billing. It is also important to contact the payor to resolve any denial issues that may be a result of insurance company error.
Payment turnaround time review
Reviewing payment turnaround time for your top 10 insurance payors can pay financial dividends to your bottom line. It is essential to differentiate between a clean claim payment vs. a secondary submission that requires your staff to intervene and resubmit the claim. Root cause identification and upfront resolution will reduce revenue cycle denials and increase payment turn around time.
Reconciliation of account balances
Review aged account balances to determine if the account balance is correct and make adjustments as necessary. You should identify the top 5 reasons the account balances are incorrect. Work through processing issues to prevent future incorrect account balances.
Credit balance review
This is a targeted review of accounts with credit balances. The need to determine if the balance is correct and liability sitting on the accounts are accurate. Identify any patient or governmental credits for immediate refund processing. Categorize root causes of accounts creating false credits and identify process flow correction.
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Simple Price Transparency Solution
06 April, 2021 -
RAC Audits and Medicare Claim Denial
08 August, 2018 -
2014 Advisory Board study revealed:
Claim denials may be a fact of life in healthcare, but inadequate claims denial management strategies could be leaving more healthcare revenue on the table than expected. About 90 percent of claim denials are preventable.
Complimentary Process Review
Let us review your "new-normal" policies and procedures and evaluate the long-term sustainability of quick pandemic fixes.
Our Complimentary Process Review Includes:
- overview report on your current process
- workflow chart
- recommendations for improvement that you can implement yourself
Ensuring Our Clients Rapidly Achieve Their Financial and Operational Goals
Our focus is to help your business grow and run smoothly. We understand the challenges faced with Revenue Cycle Audit and Denial Management. Sunlit Cove Healthcare Consultants provide professional subjects matter experts in the healthcare industry to enhance your business. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management.
Revenue Cycle Management Services
Our focus is to help your business grow and run smoothly. We understand the challenges faced within the claims processing and recovery environments. We understand the need to expand telehealth services in our current situation. Telehealth is working, but only if integrated with the right infrastructure and processes.
Experts
Our team of experts at Sunlit Cove Healthcare Consulting have a diverse skillset which allows us to focus on the unique challenges facing the healthcare industry and private or nonprofit physicians’ practices today. Our combined years of expertise in healthcare administration enables us to effectively analyze constraints, problem areas, and challenges.
Leadership | CEO
Lori Intravichit is the CEO of Sunlit Cove Healthcare Consultants. She has more than 25 years of healthcare experience. Lori has extensive experience in healthcare administration in senior management roles within both provider and payer organizations.