Revenue Cycle Management (RCM) & Optimization
Providing actionable insights into current revenue cycle operations in order to correct problem areas, improve productivity, reduce costs and increase revenue.
Baker Tilly’s wide range of revenue cycle management (RCM) solutions help healthcare providers of all sizes grow net revenue, increase cash collections, improve employee productivity, optimize existing EHR systems, and help organizations remain as competitive as possible.
Whether you need assistance assessing your organization’s current RCM performance, improving select operational areas, or undergoing a complete transformation, our team of specialists are here to help.
Navigating today’s complex environment
Contact our teamAn efficient revenue cycle is vital in establishing a financially sustainable future for any healthcare provider. However, many organizations lack in-depth insight into the many components of their RCM process, including:
- tedious tasks that are prone to human error
- productivity of full-time employees (FTEs)
- service line performance
- payer contracts not meeting benchmarks
- inaccurate recording of charge codes
- financial optimization of the EMR
- inefficient processes
Several recent factors – rising healthcare costs, tighter operating margins, staffing shortages, supply chain issues and inflation – have further exacerbated the importance of having an effective RCM process.
Breaking down the revenue cycle process
With decades of experience, Baker Tilly has the breadth and depth of knowledge needed to help evaluate and transform any portion of your organization’s revenue cycle operations. Whether it’s assessing current processes, addressing specific inefficiencies of your RCM operations, or conducting a full-scale revenue cycle transformation, our team of specialists are here to help during any of the following revenue cycle stages.
Pre-service
Pre-arrival (scheduled visits)
Patient access
There are several steps and activities that take place before the patient arrives at the hospital in order to secure payment from the insurance company and/or the patient.
Contract negotiation: Determining reimbursement and compensation rates with health plans.
Scheduling/advanced beneficiary notice (ABN): Entering the patient into the EMR system and sending out an ABN if the customer is a Medicare recipient.
Insurance/eligibility: Verifying the patient has insurance and is qualified to have the proposed procedure.
Financial clearance: Deciding if the patient can pay for the services, whether through insurance, out-of-pocket or financial assistance/charity.
Service authorization: Completing the necessary paperwork to submit the proposed procedure through the insurance company.
Pre-service
Arrival (scheduled and unscheduled visits)
Patient access
When arriving at the facility, there are additional steps taken before the procedure is provided. If this is an unscheduled visit (e.g., emergency department), some of the steps in the pre-arrival stage are also included during this phase.
Co-pay collection/point-of-service collections: Collecting co-pay or deductible, depending on if the patient is insured, or collecting cash up-front if uninsured. If the patient is a Medicare recipient, collecting payment for services or drugs not covered by Medicare or secondary insurance.
Financial clearance: Filling out the paperwork to pay for services or setting up a predetermined payment plan.
Insurance/eligibility: If it is an unscheduled visit, verifying the patient has insurance and is qualified to have the proposed procedure. If this is a scheduled visit, conduct one last verification of eligibility.
Service authorization: If it is an unscheduled visit, completing the necessary paperwork to submit proposed procedure through insurance company.
Post-service
Service integrity and documentation
Revenue integrity
Processes in the service integrity and documentation stage occur behind the scenes and are rarely seen by the patient (i.e., EMR systems, hospital host systems, patient journey activities, etc.).
Health information management (HIM)/documentation: Receiving a medical record to begin coding.
Clinical documentation: Documenting the patient and procedure in the EMR system, includes discharge or after visit summary (seen by and discussed with patient).
Charge capture/coding: Providing a diagnosis code, or multiple diagnosis codes, to justify the reason for the patient’s visit.
Charge description master (CDM) review: Auditing what is being coded and documented within the medical records for ensuring accuracy.
Clinical documentation improvement (CDI): Redeveloping workflows if documentation is inaccurate.
Post-service
Post care and financial services
Revenue recovery
The last phase of the revenue cycle process involves collecting the final payment and closing out outstanding accounts.
Contract review: Analyzing contracts for any discrepancies with payer contracts and documentation.
Billing: Sending out and automating notices of final payment from your facility.
Third-party follow-up: Collecting additional payments from insurance companies and other third parties.
Patient payment collection: Utilization of third-party vendors if there is an issue with collection of final payment from patient.
Outsource management: Outsourcing the collections process to help reduce accounts receivable (A/R).
Denial management: Flagging claims prior to submission to insurance company to prevent denials.
Cash application management: Providing select levels of interim management work to streamline collections process.
Payment variances: Identifying A/R balances that were underpaid or not paid appropriately.
Credit balances: Identifying A/R balances that were overpaid.
Bad debt management: Preventing and dealing with unpaid/outstanding account balances.
How we can help
Whether it’s assessing your current revenue cycle operations, addressing specific aspects of the RCM process, or undergoing a complete transformation, our team is here to help. Take a deeper dive into how Baker Tilly can help create a more efficient RCM process that fits your organization’s unique needs.
Assessing current operations
By taking advantage of process level data and combining it with Baker Tilly’s experience and proprietary set of tools, we can help management teams better understand their revenue cycle performance – identifying root causes quickly so that corrective action can be taken early and reduce and eliminate potentially large drains on annual revenues.
Whether it’s evaluating a particular subset of your revenue cycle process or your entire operations, our team will identify gaps and actions needed to achieve real results. Our process includes:
- Gathering and analyzing data
- Conducting on-site interviews
- Observing key processes
- Measuring payment accuracy
- Creating a road map for quick wins and long-term improvements
Addressing specific segments of the revenue cycle process
The RCM process has many facets, and we realize most organizations do not need a full-scale revenue cycle transformation improvement. Because of this, our team can work with you to help correct and optimize areas where corrective action is most needed, including the pre-arrival, arrival, service integrity and documentation, and post-care and financial services RCM stages.
Managing traditional payer and value-based contracts
Successfully setting up, negotiating and managing contracts with payers is a key component of revenue optimization. From ensuring contracts are meeting industry benchmarks to managing contracts to ensuring you are getting paid established rates to negotiating traditional fee-for-service (FFS) and innovative value-based care (VBC) contracts, our team is here to help.
Streamlining process and automating repetitive tasks
Steps taken within the RCM process can often be tedious, repetitive and prone to human error. With Baker Tilly’s depth and wide range of skillsets, we can identify inefficiencies, create best practices and implement consistent processes throughout the RCM cycle.
In addition to changing basic workflows, our team can help streamline complex processes and automate mundane tasks with robotic process automation (RPA) and automation intelligence (AI). With this combination, our team can help increase employee productivity so that more time can be spent on higher value-added tasks, eliminate human error, and more easily identify alerts that can help reduce denials, recognize and manage underpayments, reduce AR turnover ratios and more.
Optimizing existing EMR systems
Because medical records are fundamental to every aspect of healthcare, it is necessary to understand how they are used within an organization. Baker Tilly understands how processes and systems work together and incorporates your existing EMR into the planning process to improve workflows and documentation capture make sure your system is operating as efficiently as possible, including:
- Performing a readiness assessment of current workflows
- Completing interviews to establish future workflow needs
- Providing an analytical review and GAP analysis of these workflows
- Developing and providing training for hospital staff
- Participating in testing, training and go-live activities
- Performing post go-live optimizations
FTE performance monitoring
It is important for providers and management teams to understand the effectiveness of their full-time employees (FTE). Tracking of FTE performance can also enhance individual performance, improve employee morale and lead to greater commitment and longer retention for FTEs, even in a work-from-home (WFH) environment.
With Baker Tilly’s proprietary software, we are able to help your organization have better visibility into FTE performance. This includes insights and metrics to benchmark employees for improved operational outcomes, and insights into how to address negative performance.
Conducting a full-scale transformation
With a large-scale RCM transformation, our team can conduct diagnostic reviews of key revenue cycle functional areas driven by data analysis and on-site interviews. We also document conceptual future state performance based on Baker Tilly experience with best-in-class operations and develop initial opportunities for operational and financial improvement. We also compare managed care contracts to determine appropriate benchmarks, payer payment accuracies and denial trends.
After our diagnostic stage, we execute upon mutually agreeable quick win improvements and develop a detailed plan to resolve the systemic issues previously identified. We then start the larger transformation process – which depends on findings from the evaluation stage – and begin executing process and organizational transformation along with optimization of existing technology.
After completion, we also develop a strategic road map to help drive long-term accountability and sustainability through our monitoring services that provide dedicated and experienced “preventative maintenance” for your revenue cycle operations.
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