Revenue integrity in healthcare means using ethical and standard business policies and practices to meet the three most important imperatives of compliance, operational efficiency, and optimal reimbursements. Focusing on all the three together and making them work in tandem can lead to the healthy operations of a practice.
Flatworld Solutions has over 20 years of experience in providing healthcare revenue integrity services to large and small practices in the US and around the world. Over the years we have assisted several healthcare facilities to pivot their revenue integrity services across a set of specific set procedures and guidelines that all stakeholders need to practice and follow. Our healthcare revenue integrity services assist our clients to catch overpayments and underpayments on time, reduce the risk of external audits, and bring payment denials under full control. In the process, we assist our clients to save precious time and money for the organization.
Our Healthcare Revenue Integrity Services
As a renowned healthcare revenue integrity company, we offer our clients a range of services. These include -
Develop a Comprehensive Revenue Integrity Program
With this service, we assist our clients to draw a robust and foolproof plan to strengthen their revenue integrity program. The plan outlines how to apply our expert services and technical know-how to boost coding and charge accuracy, improve clinical documentation and compliance, reduce DNFB, and deploy a top-notch quality assurance process to improve the quality of the RCM process. Our clients bank on our expertise to identify issues, find out the right fixes and implement the fixes smoothly.
Clinical Documentation Improvement
Clinical documentation is a critical aspect of healthcare compliance and revenue cycle efficiency. With our clinical documentation improvement services, we assist practices to improve the overall quality of clinical documentation and ensure clinicians outline healthcare services most accurately. Our specific CDI services include assisting you to identify trends of specific procedures and diagnoses, spot gaps in clinical documentation for every procedure/ diagnosis, familiarize clinicians with sensitive issues in clinical documentation, and enabling smooth communication dialogue between physicians and team members.
Charge Capture Audit Services
Healthcare practices have to put up with a lot of revenue earning misses because of existing holes in the system. For some practices, this adds up to a significant sum. Our charge capture audit assists our clients to review bills to identify any chargeable opportunities that went unnoticed. During this process, we carry out an end-to-end review of the overall procedure followed, document the procedure, and identify whether underbilling is happening in your practices. Once we identify the gaps, we develop a strategy to close the loopholes and improve the efficiency of charge capture by working with medical billers, coders, and physicians.
Access Medical Coding Expertise
Hiring skilled professionals to strike a balance between productivity and performance and improving revenue without violating compliance is a constant struggle for providers. And when this happens in the face of changing rules like in the face of a pandemic, coding can become all the more challenging. We have a team of experienced coders who keep a tab on the changing rules. Besides supporting providers with common coding requirements, our coders provide coding support during backlogs, system changes, and manage coder attrition. We have trained our team to handle multiple billing systems with expertise, which is why we always deliver quickly giving you room to focus on core priorities.
HIM Coding Review
An important aspect of medical billing, and therefore healthcare revenue integrity is ensuring proper use of CPT and HCPCS codes and DRGs. Our HIM coding revenue services are dedicated to meet this particular need of providers. We validate internal and third-party use of ICD-10-CM codes, particularly sequencing of the principal and secondary diagnoses and ICD-10-PCS codes for assigning MS-DRG. We also ensure the assigned code is present on admission forms and discharge summaries. We take care of all types of coding reviews such as clinical coding review, physician coding review, outpatient coding review, etc to guarantee the integrity of the process.
Payment Variance Analysis
A major cause of healthcare revenue leakage is failure to identify incorrectly reimbursed dues or process denied accounts on time and without any further mistakes to receive correct payment. It is here that we step in with all our expertise to plug the oversight. We have a detailed checklist-based process followed by an expert review to understand the variance in payments. From matching demographics to coding, from detecting under coding to upcoding, from poor documentation to No EOB, we look into every aspect of billing to establish the reason for payment variance. In the process, we assist you to streamline denial claims management.
Our Healthcare Revenue Integrity Process
As a renowned healthcare revenue integrity service provider, we assist you to develop integrity into your process in the following ways -
01. Understand Your Requirements
We sit with you to understand your pain points. This helps us to draw the right strategy for improving the integrity of your process as well as identifying one of the aptest healthcare revenue integrity solutions
02. Form Team of Experts
We form a team comprising clinical, administrative, and revenue cycle experts. The team will coordinate with all the key stakeholders of your practice such as supply chain, decision support, pharmacy, IT, and compliance to understand the respective challenges
03. Identify and Fill Business Process Gaps
In this step, we view all your existing workplace policies and evaluate your workflows to find gaps in the operating model. Based on this knowledge we draw a repurposed plan to arrest revenue leakages
04. Establish KPIs
Once the flaws are detected and a remedial plan is drawn up, we set up the key performance indicators to measure the performance of each of the clinical departments to reduce errors that lead to denials
05. Identify Underperforming Clinical Departments
Once the KPIs are established we activate the monitoring process. This helps in identifying the clinical departments that are lagging in performance. Performance gaps are pointed out and resources are deployed to resolve every performance aberration
06. Establish a Robust Communication Process
As the last step towards plugging all loopholes in the healthcare integrity process, we provide all your staff who are responsible for revenue capture comprehensive training on new regulations, system updates, and routine CPT codes. We also establish a clear communication process to promote high-performance standards
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Why Outsource Healthcare Revenue Integrity Services to Flatworld Solutions?
Outsourcing healthcare revenue integrity services to us brings a lot of benefits to healthcare practices. As a reputed healthcare revenue integrity service provider, we offer benefits such as -
Outsourcing healthcare revenue integrity services leads to huge savings in costs accompanied by a rise in collection rates. This is primarily because we offer the services of experienced billing staff and certified coders at a cost that is profitable for them and at significantly fewer expenses for you. Besides, we make use of advanced revenue tools to improve the collection of revenues for your practice.
Focus On Patients for Improved Experience
When employees of a practice are tasked with developing and implementing a good revenue integrity program, they are completely taken up by the high volume/low reimbursement culture of revenue management. However, by outsourcing this program, you free up the time of your employees and ensure they focus more on patient care thus helping improve the patient experience.
Bring Every Denied Claim Back to the Table
Healthcare revenue integrity service providers understand how to handle denied claims effectively. This is because their understanding of denials is honed by vast exposure to denial management. Besides resources, they have the technology necessary to streamline the process after bypassing all its complexities. By outsourcing denial management you simply reassign the task to someone who knows how to manage it more strategically and with patient-centric efforts.
Establish Compliant Processes
A healthcare revenue integrity program must be in line with federal initiatives such as proper use of ICD-10 and value-based purchasing. This means continuous training of RCM staff on federal mandates which is a time-consuming and stressful process. With healthcare integrity outsourcing, hospitals can handle the changing requirements of the industry and even payer policies. This helps in maintaining a compliant healthcare revenue program while meeting the objective of increased revenue.
Increase Revenue without Disrupting Your Existing Workflows
One big challenge practices have to face regularly with revenue management is changing technologies. For any busy practice, this is a mammoth task. By outsourcing healthcare integrity services, practices don't have to face this trouble. We are quick to adapt healthcare technologies and can help you develop workflows that are advanced without having to spend anything on technologies. This way, practices can keep their revenue inflow intact without being impacted by the influence of changing technologies.
Customer Success Stories
FWS Enabled a Medical Foundation By Providing Rehabilitation Transcription Services
We helped a leading medical foundation move its data to a new EHR software and also provided robust rehabilitation transcription services at cost-effective rates.
FWS Delivered Professional Medical Billing Support to the Largest Medical Billing Services Provider in the US
A leading medical billing firm from the US outsourced AR follow-up, eligibility verification, and pre-authorization services to us. We delivered high-quality services within a quick time.
Outsource Healthcare Revenue Integrity Services to Flatworld Solutions
I am very satisfied with your work and feel that it has been getting better and better. It has helped me immensely and I appreciate it.Doctor, Thyroid and Endocrine Specialists, Houston More Testimonials »
Flatworld Solutions has over 20 years of experience in providing highly effective healthcare revenue integrity programs to small and big practices in the US and around the world. We integrate our solutions with revenue management practice to prevent revenue loss or delay in payments. We ensure this by plugging all loopholes in the billing and coding process and providing end-to-end compliance across the revenue cycle. Our clients bank on our services to battle the complexities in regular healthcare policy changes, and prevent revenue issues that keep cropping because of these changes.
If your business is looking for the best healthcare revenue integrity service providing company, get in touch with our experts now.
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