Bruce Adler
medSR
Vice President, Revenue Cycle Practice Director
As much as 1% of net charges are lost due to charge integrity leakage” or about $2 million in net revenue – (HFMA 8/23/2017 avoiding the high cost of high-capture leakage); (Definitive Healthcare, cost report results on 5,145 Us hospitals assessed March 2022 using $207 million NPR in 2022 ,4% inflation applied)
40% of revenue cycle leaders stated that 4-7 days typically expire between charge capture and claim submission” -(1/8/19 Ingenious Med study on how charge capture is conducted and perceived)
medSR can help your organization find new streams of revenue that resuscitate declining margins and accelerate the realization of revenue. Our comprehensive approach to assessing net revenue opportunities starts with identifying revenue leakage risks within the Revenue Cycle, recommending mitigation strategies, and implementing those strategies quickly.
Our approach will provide optimization of both the charge description master (CDM) and charge capture processes through a comprehensive assessment. The assessment includes the following components:
Charge Description Master (CDM)
- Assess correct coding and assignment of CPT, HCPCS, ICD-10, Modifiers, and Revenue Codes
- Validate compliance with Government and Commercial reimbursement guidelines
- Identify charging vulnerabilities as well as opportunities
Strategic Pricing
- Identify opportunities for price re-alignment through the analysis of revenue, usage, and market data
- Develop a pricing strategy that optimizes net revenue and ensures defensibility
Documentation Improvement
- Evaluate the quality, completeness, and timeliness of medical documentation
- Audit the appropriateness of procedure and diagnosis coding
- Identify documentation risk areas and recommend improvement strategies
Rejection Mitigation
- Analyze and trend charge lags and claim rejections
- Validate that expected payments were received and analyze variances
- Implement effective strategies that proactively mitigate rejections
The medSR Revenue Cycle Management team is a dynamic group of seasoned healthcare professionals who specialize in revenue cycle excellence. We leverage extensive industry knowledge to measurably improve revenue cycle performance.
Author: Bruce Adler, Vice President, Revenue Cycle Practice Director
