Our Understanding of the Business
Provider Challenges:
- Revenue loss from inaccurate and incomplete coding practices
- Elevated denial rates and low first-pass rates causing cash flow challenges
- Prolonged aging of accounts receivable and low collection rates for patient responsibilities post-checkout
- Lack of emphasis on accounts receivable management
- Lengthy and demanding credentialing processes leading to delayed payments
The current imperative is a pressing necessity.
- Trained professionals in medical coding ensuring adherence to the latest standards in both medical and procedural coding practices.
- Utilization of models and algorithms for data analysis to enhance the entire payment process.
- Experienced medical billing personnel working towards higher first pass rates, decreased penalties, and diligent follow-up on claims until revenue is successfully obtained.
- Dedicated accounts receivable management staff committed to pursuing every outstanding dollar.
Key Drivers
A collective of Certified Professional Coders accredited by AAPC.
Enhancing RCM speed through the utilization of seasoned personnel.
Customized, comprehensive solutions for Revenue Cycle Management (RCM) operations.
Comprehension of the provider landscape and its associated challenges.
Out Comes
Precision and efficiency in operations.
Reduced Reworks
& overhauls
Simplifying the payment procedure.
Outcome-driven delivery model.
Value Proposition
Our Strengths
- Extensive knowledge of healthcare procedures for providers.
- Over a decade of experience in Revenue Cycle Management (RCM) and a team of certified coding professionals.
- Specialized Healthcare Center of Excellence (CoE) supporting project delivery
- Enhance cost efficiency through the utilization of tools and accelerators for process optimization
- Adherence to 100% process and coding guidelines
- Full implementation of HIPAA compliance guidelines
- Reduce accounts receivable (AR) through a follow-the-sun coverage model
- Adopt a flexible pricing structure by transitioning to outcome-based pricing
- Prepared for dynamic scope and schedule adjustments with a fixed and flexible team
- Achieving a 98% level of process and transaction quality
- Robust adherence to Standard Operating Procedures (SOP) and thorough documentation
- Utilization of a root cause analytics dashboard
Out Comes
- Enhanced cash flow by 30%
- Minimized operational costs by at least 60%
- Decreased accounts receivable (AR) ageing to below 60 days
- Empowering provider staff to focus on clinical outcomes
Flexible Pricing Models
Our pricing models are designed to meet short-term and long-term needs of ourclients.
We offer flexibility, scalability, efficiency and cost benefits at various levels andthroughout the engagement.
Full-Time Equivalent (FTE) Costing
Determined by multiplying the average FTE rate per hour with the required number of FTEs for task completion (effort estimation).
Ideal When
1.Transaction volumes are uncertain
2. Transaction volumes are not closely linked to the service provider’s cost drivers
Benefits
1. Flexible, scalable, and modular structure
2. Reduces overall project costs
Revenue Percentage
This represents outcome-based pricing that mutually benefits both the Provider and the RCM vendor. It encourages the RCM vendor to optimize the Provider’s revenue.
Ideal When
1. A fixed percentage of revenue is determined for any or all agreed-upon services with the Provider
2. Desired outcomes and accountability can be clearly defined and documented
Advantages
1. Straightforward to comprehend and implement
2. Predictable and stable throughout the contract duration
Transaction Volume-Based
Determined by the number of transactions completed within specified timelines, often on a monthly basis. Pricing is influenced by committed volumes, and visibility is established through mutually agreed-upon deliverables.
Ideal When
1. Output can be clearly defined
2. Transaction volumes are known and predictable
3. Transaction volumes are linked to the service provider’s cost drivers
4. Not suitable for transactions with variable efforts based on each transaction
Advantages
1. Closely aligned with the customer’s business cycle (OPEX)
2. Improves visibility into consumption patterns
Promotes productivity and efficiency enhancements
HIPPA Compliance Measures
Our pricing models are designed to meet short-term and long-term needs of ourclients.
We offer flexibility, scalability, efficiency and cost benefits at various levels andthroughout the engagement.
- Intrusion Detection System (IDS) and Firewall, Dedicated VLANs
- Prohibition of remote access, ensuring secure connectivity
- Restriction on personal laptops and devices
- Implementation of vulnerability analysis and penetration testing
- Secured cabling for enhanced protection
Data center access controlled through biometric authentication - Utilization of Department of Defense (DOD) wipe, with restricted admin rights
- Hardware lock, with disabled USB and CD-ROM access
- Centralized patch management and utilization of hardened operating systems
- Standardization of software and servers within the data center
- Implementation of centralized anti-virus measures and regular backup protocols
- Adherence to non-disclosure agreements before accessing any client or patient data
- Mandatory HIPAA training for employees through an online program by Virtuous and internally
- Transition to a paperless environment for improved security.
- Round-the-clock security personnel and CCTV surveillance
- Use of photo IDs for identification
- Implementation of magnetic swipe-card and biometric access controls
- Controlled access to specific units with visitor escorts
- Formal approval process for ID creation
- Assignment of individual mail and LAN IDs
- Enforcement of a robust password policy, including encrypted passwords
- Implementation of an automated access release/deactivation process
- Special access granted only with approval from the Client Data Center and Compliance Office
- Limited internet access with restrictions on upload/download and attachments
- Prohibition of access to free email, instant messaging, and social networking sites
- Reporting of non-compliant incidents to the Data Security and Compliance Officer.
Our Healthcare COE
Easily deployable team of Revenue Cycle Management (RCM) specialists.
Resource Mix
- Certified Medical Coders
- Pharmacist
- Allied Health Professionals
Trained Professionals
- Certified in CPC, CCS, and BCHHC
- Proficient in ICD-10 coding
- Specialized in multispecialty coding
- Expertise in pharmaceutical coding
- Proficient in coding audits
Core
- Training before processing
- Understanding of the US Healthcare domain
- Effective communication skills
Competency
- Experts in Coding
- Compliance with HIPAA and Technology
- Knowledge in Anatomy and Pathophysiology
Competency
- Anesthesia, Surgical Day Stay (SDS), Inpatient Diagnosis-Related Group (DRG)
- Hierarchical Condition Category (HCC), Evaluation and Management (E/M) for Outpatient and Inpatient, Emergency Department (ED) Professional Fee and Facility, Pathology
- Home Health Coding, Radiology
Critical Success Factors
Onsite travel of RCM specialists for transition at company expense Efficient onboarding of Program Management and Operations Teams Logistics planning and team ramp-up/ramp-down Reduced learning curve by leveraging existing process knowledge
Revenue Cycle Management Operations Experience
(Mid-size West Coast Hospital)
Highlights
- Certified team of Medical Coders and RCM Analysts
- Foundation-based Medical Coding and Billing edits/charge entry
- Services include Charge entry and review, Medical coding, Manual charge entry, Posting, and Payment posting
- Daily processing of 100% of assigned charts/patient sessions
Business benefits
- Substantial decrease in accounts receivables, from $90 million to under $20 million
- Significant reduction in backlog across various departments, including lab, EKG, radiology, urgent care, and optometry
- Attained coding quality exceeding 98% for outpatient medical coding
- Ensured 100% charge capture, billing for every service performed
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