Net Health RCM Solution
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FIND THE PATH TO HEALTHY REVENUE
description
Revenue cycle management (RCM) for Urgent Care and Occupational Medicine facilities
Transcript of Net Health RCM Solution
FIND THE PATH TO HEALTHY REVENUE
Developed by:
Gene Howell, CEO & Co-Founder
InsightRCM
&
IMPROVE REVENUE FLOW & COMPLIANCE w/ RCM
If you’re seeing a longer A/R story than you’d like, repeated claim
denials, have a growing pile of appeals, or find yourself downcoding
some services because you’re unclear about the necessary
documentation, then you will benefit from expert Revenue Cycle
Management (RCM).
A great revenue cycle starts with confident documentation from an
EHR that guides visits to the most appropriate E&M level. Chart
analysis by Urgent Care and Occupational Medicine experts
ensures accurate industry coding. Taking processing out of your
office streamlines your operations and puts the whole system into
the hands of revenue experts that guarantee your compliance.
REVENUE CYCLE MANAGEMENT
A full service solution that incorporates best practices for workflow, coding, chart
analysis, billing, claims processing, payment, appeals, and collections. It’s a comprehensive solution that begins with driving providers through visits that attain
the strongest, appropriate levels.
End-to-end
systematic
approach
Optimize earned revenue,
documentation
efficiency, & compliance
Complete, EHR
driven docu-
mentation
WHAT’S A CPC?
Trained to
analyze UC/OM
medical charts
Gold standard for
medical coders Experts in ICD-9,
ICD-10, CPT-4,
& HCPCS codes
Able to update &
correct codes in a
patient chart
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Specialty CPCs (certified professional coders)—drive best revenue
opportunities with proper documentation.
FIVE BEST PRACTICES
Ensure EHR workflow leads providers through the right clinical
documentation, like Agility’s PACErs—capture accurate and
complete supporting documentation automatically.
Use electronic billing to reduce days in A/R—increase cash flow.
Automate appeals management—ensure there’s no money left on
the table.
Continuously monitor to ensure that documentation meets medical
justification and necessity (including regulatory compliance)
USE A SPECIALIST
#1
Urgent Care or Workers Compensation services
aren’t the same as family practice. Why would
you use the same coder?
Not all CPCs are the same. For your specialized medical facility you
need specialized revenue cycle knowledge. It’s imperative to your
financial success that you’re billing the most appropriate types of
work for each visit.
What’s gained from an expert CPC? Command of the intricacies of UC/OM coding, billing, and claims processing
An expert trained to read and analyze UC/OM medical charts
and strategically advise on billing codes supported by
treatment documentation
Constant monitoring of UC/OM industry news means they know
changing regulations and carrier denial patters. Use this knowledge to minimize impact at your facility
Did you know: an industry expert CPC find gaps where you’re
not billing or correct coding behavior that’s not compliant
SUPERCHARGED EHR
#2
“Technology is the new workforce multiplier.” - Pricewaterhouse Coopers, Top 10 Healthcare Issues for 2014
An EHR with guided workflow is the best tool you have to ensure
the complete supporting clinical documentation to drive the
highest appropriate level attainment at each patient visit.
Don’t spend extra time hunting for functions, buttons, or fields.
Eliminate the stress of guessing how to raise E&M levels . Ensure your EHR has embedded guides that lead you right to orders.
Providers reclaim the most time in their day by following an
automated workflow that confidently provides full supporting
documentation
Best-in-class UC/OM software understands the impact of both
visit level and coding-billing, and will guide documentation to
drive both revenue and compliance
Did you know: A powerful EHR will have a dashboard that lets
you check the E&M level of your visit, instantly
ELECTRONIC BILLING
#3
Take advantage of electronic billing to shorten
your billing cycle and drive increased monthly
cash flow.
Electronic billing can be a huge leap in efficiency for your
facility—especially if you have appropriate automation processes
established.
Insist on electronic submissions. Don’t rely on a human brain to
remember to do it or process it.
Integrate information about standard charges and revised fee
schedules as soon as you know there’s a change—keep the
system flowing accurately
Use software automation to bill encounters accurately. For OM
client (employer) work, automate periodic statements (weekly,
monthly, quarterly) for your billing cycle
Did you know: full chart notes must be attached to Workers
Compensation billing?
AUTOMATE APPEALS MANAGEMENT
#4
Data shows that 65% of claims are never
appealed. That means 10-20% of your money
could be left on the table.
Know when you can’t avoid appeals, strictly based on payer
behavior. Minimize appeals, but automate the submissions process
when they’re needed, minimizing days to revenue.
The best RCM services get it right the first time.
RCM strategies are focused on limiting the need for appeals through appropriate supporting documentation
But, appeals are necessary! The Net Health RCM Solutions secures
payment in 70% of appeals.
Payers regularly alter their patterns of denials that cause common
appeals—a UC/OM expert RCM service is up to date on this
information to keep appeals to a minimum
Did you know: Some states allow only one appeal. Others charge
for a second appeal. It’s critical to get it right the first time!
MONITOR FOR CHANGES
#5
It’s a specialized industry. Changes are always
afoot that will directly impact reimbursement,
compliance, and the success of your business.
Consider the team in your back office. Do they have time to step
out of that role to educate themselves on the broader picture of
the industry? Regularly?
There’s a lot to know. Specialized CPCs, working with your RCM
service, bring this timely, actionable information to your facility.
Experts are aware of payer changes in advance and can alter
your billing tactics to accommodate
Invaluable experience teaches you the tricks of the trade
related to UC/OM billing (like proper coding patterns for specific
medications)
Did you know: expert CPCs drive efficiency in your DME orders—
stock the most reimbursable and clinically effective items
REAL LIFE EXAMPLES
Average Net Health RCM
Solution Performance:
50% reduction in claim denials
70% success rate on appeals
Highlights of
Client Results:
Increase in collections per chart
Workers Comp, Orthopedics,
Physical Therapy, Urgent Care
Increase in total collections
Workers Comp, Physical Therapy,
Urgent Care
Increase in total collections (w/ improved compliance)
Workers Comp, Orthopedics,
Urgent Care, Primary Care
18%
16%
8%
GET NET HEALTH RCM
Consult an
Agility
specialist
Let us evaluate your current situation. For real evidence, let
Net Health RCM experts review
up to 5 charts, free.
Implement
Agility Software
with RCM
GET NET HEALTH RCM
Consult your Agility
Account
Executive
Once RCM is
purchased, immediate
implementation and
training launches
enhanced workflow
Let us evaluate your current situation. For real evidence, let
Net Health RCM experts review
up to 5 charts, free.
