Audit and Reconciliation

Hospitals & Medical Practices
Daily 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 analysis and audit reconciliation can lead to cash collection reduction and costly overhead to obtain the correct payment from the payer.

Sunlit Cove Healthcare Consultants provide the following services:

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 claim 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.

qode-eliptic-slider

Navigating the dynamic and complex revenue cycle arena is a challenge for many health plans, health care vendors, and providers.

We simplify it.

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 the claims processing and recovery environment. 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.

Sunlit Cove Healthcare Consultants, Revenue Cycle Change Management

Sunlit Cove Healthcare

Our focus is to help your business grow and run smoothly. We understand the challenges faced with the claims processing and recovery environment. Sunlit Cove Healthcare consultants provide professional subjects matter experts in the healthcare industry to enhance your business.

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.

Sunlit Cove Healthcare Team

Experts

Our team of experts at Sunlit Cove Healthcare Consulting have a diverse skillset which allow us to focus on the unique challenges facing the healthcare industry today. Our combined years of expertise in healthcare administration enables us to effectively analyze constraints, problem areas and challenges.