Specific services include:

• ​​Patient Access: We have assisted our clients with developing processes and procedures for gathering accurate and complete patient demogr​​​aphic, financial, and medical diagnostic information including:
  • Developing pre-registration and registration po​​licies and procedures including obtaining the necessary information to comply with payor requirements
  • Developing training materi​​als focusing on critical areas of the registration process and providing training to staff
• Charge Capture: We have assi​​sted our clients with the timely co​ding, collection and recording of patient charges by:
  • Revising, testing and assisting ​with the implementation of updated order and charge screens and design of charge slips
  • Developing char​ge description master maintenance policies and procedures
• ​​​Billing and Collection We have assisted our clients with the timely billing and collection of third party payor claims. Our​​ work assisting both payors with implementing claims processing systems and providers with implementing patient accounting systems, makes us uniquely qualified to assist clients to resolve billing issues. Our experience in this area includes:
  • Assisting a major payor with the implementation of a claims processing system, including assisting with modifying claims edits and adjudication procedures to improve timely resolution of claims
  • Accelerating cash collections and resolving billing backlogs, including providing training to billing staff, review of denials, rebilling claims and meeting with payors to resolve issues
  • Developing procedures for the timely resolution of bill edits by different departments
  • Reviewing new services with departments to identify billing procedures and related system modifications
  • Reviewing file maintenance to reduce the number of manual corrections to claims
  • Forming a revenue cycle task force consisting of admissions, medical records, patient accounting, utilization review and contracting staff to review and identify the impact of changes to payor requirements and changes to facility services
  • Implementing a patient accounting scorecard to measure performance and monitor aging accounts receivable
• ​​Denial Management: We have assisted our clients with developing and implementing programs to reduce denials from payers and realize appropriate reimbursements by resolving denials. Specific services provided include:
  • Identifying and implementing process improvements to reduce the occurrence of denials
  • Designing the processes and tools to track and resolve denials. This may be through identifying additional functionality for the existing patient accounting system, identifying supplemental systems or developing additional tools (e.g., informational databases, work lists and follow up reports).
  • Developing standard denial codes and identifying which department or resource is best suited for resolving each type of denial
  • Designing the process, policies and procedures for posting, tracking and resolving denials
  • Developing scorecards to track performance
  • Developing training materials and conducting training sessions
• ​​Contract Management: We have assisted our clients with developing and implementing a program to model the expected payments from payors and reconciling it to actual payments received. This includes following up on differences between expected and actual amounts to realize appropriate reimbursements. Our experience includes:
  • Developing summaries of payor contracts and modeling these contracts in a contract management system
  • Developing reports used to identify differences between payments received and actual amounts
  • Identifying ambiguous or undefined contract terms that could affect payment amounts
  • Designing the processes, policies and procedures, and forms for following up on differences, resolving contract issues and maintaining contracts
  • Developing scorecards to track performance
  • Developing training materials and conducting training sessions for the personnel involved. 
• ​Other Patient Accounting Assistance: We have also provided assistance to clients in other areas of the revenues cycle including:
  • Providing interim patient accounting department management
  • Managing temporary staff to resolve credit balances
  • Developing and implementing write-off and adjustment code policies and procedures
  • Review of billing for compliance to Medicare and Medicaid requirements​

< Back to What We Do

Revenue Cycle

Copyright SH Consulting LLC. All rights reserved.