Revenue Cycle Analytics

By Identifying and analyzing the steps within your revenue cycle process, we can locate lost revenue, identify deficiencies in the front desk process and reduce the number of denied claims by insurance companies. Also, employee and patient satisfaction can increase due to simplification of processes and accuracy of information.  Prevalent addresses each customer’s unique set of revenue cycle issues begins with a data assessment and leads to recommended technology-enabled solutions for sustainable results. We work with you to decide whether your assessment will be as simple as an accounts receivable analysis, or as detailed as a multi-day, end-to-end revenue cycle evaluation of processes, procedures, technology and key performance indicators.

Identifying areas of opportunity

  • Accounts Receivable Analysis – Accounts Receivable (AR) Review is the process of analysis and work flow necessary to adjudicate invoices that have not been paid within a certain timeframe. Adjudication of AR may lead to payments, disallowances, or write-offs of the original invoice.

  • Revenue Cycle Assessment – a comprehensive and discrete on-site assessment captures current revenue cycle performance and identifies opportunities for short-term and long-term improvements using a three-step process:

    1. Gathering data and analysis – key financial and operations data guides the assessment to optimize time on-site.

    2. On-site assessment – pre-scheduled department walk-throughs' and interviews assess:

    • Organizational structure

    • Revenue cycle functions for Patient Access Services, Health Information Management and Patient Financial Services

    • Staffing levels and capabilities

    • Current policies and procedures

    • Workflow processes

    • Technology systems

    • Performance levels

    1. Findings and recommendations – we share preliminary findings throughout the process. Detailed final recommendations for improved performance, with an estimate of financial outcomes, can offer various solutions up to full management of the revenue cycle.

Frequently Asked Questions (FAQ)

  1. Are the medical necessity coverage policies sensitive to effective and termination dates of the policies and services?

    • Yes. All policies are maintained with effective and termination dates all the way down to the diagnosis-specific level.

  2. What is the accuracy rate of your data?

    • Over 99.99% upon audit. Over the past 5 years, we have made an average of 11 policy corrections per year.

  3. Many CPT codes are associated with a frequency.   Does the product provide this information?

    • Yes, we provide frequency information. This can be provided in a frequency code field or in a free text format for parsing and managing denial work queues and alerts.

  4. What is your policy regarding quality assurance and error corrections?

    • We provide same-business day correction of any errors we make. Where there is an issue that requires verification or correction by Medicare, we begin that process within 1 business day of the request and follow-up until the issue is resolved. Once resolved, necessary updates are made within 1 business day.

  5. Do you include policies that are not supported with an “all inclusive list” (permissive)?

    • Clients may choose to include or exclude permissive edits, or include them with a special notation that they are permissive.

  6. Do you support bundling/unbundling issues?

    • Yes, we provide edits for Medicaid, Blue Cross/Blue Shield, United Healthcare, Aetna, and many other private and commercial payer databases.  Contact our office for a current list of available edits.

  7. Are the specific policies referenced within the data?

    • Yes, we include the policy name, number, and a link to the full policy.

  8. Are ABN modifiers recognized for error resolution when a medical necessity edit is encountered?

    • Yes

  9. Do you offer insurer edits other than Medicare?

    • Yes, we provide edits for Medicaid, Blue Cross/Blue Shield, United Healthcare, Aetna and many other private and commercial databases.

 

Prevalent, Inc. a subsidiary of Axcension, Inc.

For more information or to see a demo of our product please contact us today.

23537 Kingsland Blvd Suite 124, Katy, TX 77494    l    (832) 413-5990  contactus (@) prevalenthealth.com

 

 
 
   

 

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