Revenue Cycle Management

TCG is focused on improving your entire healthcare services revenue cycle. This cycle starts with scheduling and ends with cash collections. Throughout the revenue cycle breakdowns can occur. Rarely revenue cycle problems stem from a single source; in our experience you find deficiencies in education, training, staffing levels, workflow, or poorly implemented computer software. Each deficiency presents an unacceptable risk and must be addressed as part of a comprehensive solution.

Schedule an Appointment
  • icon
    Patient Access Care Assessment

    Our experienced Patient Access Consultants gathers information necessary to assess department staffing, skills, processes and system usage.

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    Revenue Integrity Assessment

    Our consultants work closely with your organization’s existing multi-disciplinary teams using a work by exception approach to ensure optimal charge levels and a clean billing environment.

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    Accounts Receivable Assessment

    We will analyze your 837 Electronic Claim Filings and 835 Electronic Remittance Processing transaction activities to assist in determining deficiencies.

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    Optimizing Operations and Financial Results

    TCG will provide a written work plan containing the assessments of your overall revenue cycle operations, and recommendations for the creation, implementation and monitoring of workable solutions.

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    Cash Acceleration

    TCG will zero in on backlogs in accounts receivables.  Most healthcare organizations do not have the staffing needed to follow up on outstanding receivable once the business offices falls behind in billing and collections.

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    Denial Management

    Based on hospitals surveys, managed care claims in a “denied state” range between 10-20% of open A/R.  Therefore at any given time, a hospital with $20 million monthly net revenue will have $2-4 million in an open perpetual status of denial.

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    Interim Management

    Innovations in the financing and delivery of hospital care are occurring at lighting speed.  A skilled interim can play a unique role in positioning the incoming revenue cycle leader for success.

  • icon
    MEDITECH Process Improvement Program

    TCG has developed a MEDITECH specific process improvement program for healthcare organizations that have MEDITECH but are still struggling with optimizing performance around billing and accounts receivable.


Revenue Cycle Management

TCG is focused on improving your entire healthcare services revenue cycle. This cycle starts with scheduling and ends with cash collections. Throughout the revenue cycle breakdowns can occur. Rarely revenue cycle problems stem from a single source; in our experience you find deficiencies in education, training, staffing levels, workflow, or poorly implemented computer software. Each deficiency presents an unacceptable risk and must be addressed as part of a comprehensive solution.

Schedule an Appointment
  • icon
    Patient Access Care Assessment

    Our experienced Patient Access Consultants gathers information necessary to assess department staffing, skills, processes and system usage.

  • icon
    Revenue Integrity Assessment

    Our consultants work closely with your organization’s existing multi-disciplinary teams using a work by exception approach to ensure optimal charge levels and a clean billing environment.

  • icon
    Accounts Receivable Assessment

    We will analyze your 837 Electronic Claim Filings and 835 Electronic Remittance Processing transaction activities to assist in determining deficiencies.

  • icon
    Optimizing Operations and Financial Results

    TCG will provide a written work plan containing the assessments of your overall revenue cycle operations, and recommendations for the creation, implementation and monitoring of workable solutions.

  • icon
    Cash Acceleration

    TCG will zero in on backlogs in accounts receivables.  Most healthcare organizations do not have the staffing needed to follow up on outstanding receivable once the business offices falls behind in billing and collections.

  • icon
    Denial Management

    Based on hospitals surveys, managed care claims in a “denied state” range between 10-20% of open A/R.  Therefore at any given time, a hospital with $20 million monthly net revenue will have $2-4 million in an open perpetual status of denial.

  • icon
    Interim Management

    Innovations in the financing and delivery of hospital care are occurring at lighting speed.  A skilled interim can play a unique role in positioning the incoming revenue cycle leader for success.

  • icon
    MEDITECH Process Improvement Program

    TCG has developed a MEDITECH specific process improvement program for healthcare organizations that have MEDITECH but are still struggling with optimizing performance around billing and accounts receivable.


Patient Access Care Assessment

It has been reported that some 1 in 5 claims are rejected by health insurers.  Based on hospitals surveys, purchase managed care claims in a “denied state” range between 10-20% of open A/R.  Therefore at any given time, recipe a hospital with $20 million monthly net revenue will have $2-4 million in an open perpetual status of denial. On the other hand, hospitals reported 98% of denied claims are overturned and ultimately paid correctly.  Situations at each hospital are unique – it depends on the individual revenue cycle processes and computer systems, clinical service offerings, payer mix and contract structure.

Denials are refusals to pay as a result of the healthcare organization not adhering to insurance company policies and procedures, or pending receipt of additional information. TCG can help your organization fix root causes and resolve issues preventing payment for services rendered.

Underpayment

• Incorrect payment resulting from pricing inaccuracies or differences in contract interpretation

• Undetected Underpayments

Addition Information Required

Incorrect payment due to incomplete or inaccurate billing

• Charges or codes missing from the bill and are thus never considered for payment

• ER claim pending receipt of medical records

• Drug/implant reimbursement pending receipt of invoice

• Secondary payment pending receipt of primary EOB

Process Breakdown Issues

Elective service was not pre-authorized

• Days, service, or level of care has no concurrent authorization

• Insurer not financially responsible

• Service not covered by health plan

• Charge/procedure should have been bundled

• Untimely submission of claim


Patient Access Care Assessment

It has been reported that some 1 in 5 claims are rejected by health insurers.  Based on hospitals surveys, viagra 40mg managed care claims in a “denied state” range between 10-20% of open A/R.  Therefore at any given time, viagra 40mg a hospital with $20 million monthly net revenue will have $2-4 million in an open perpetual status of denial. On the other hand, hospitals reported 98% of denied claims are overturned and ultimately paid correctly.  Situations at each hospital are unique – it depends on the individual revenue cycle processes and computer systems, clinical service offerings, payer mix and contract structure.

Denials are refusals to pay as a result of the healthcare organization not adhering to insurance company policies and procedures, or pending receipt of additional information. TCG can help your organization fix root causes and resolve issues preventing payment for services rendered.

Underpayment

• Incorrect payment resulting from pricing inaccuracies or differences in contract interpretation

• Undetected Underpayments

Addition Information Required

Incorrect payment due to incomplete or inaccurate billing

• Charges or codes missing from the bill and are thus never considered for payment

• ER claim pending receipt of medical records

• Drug/implant reimbursement pending receipt of invoice

• Secondary payment pending receipt of primary EOB

Process Breakdown Issues

Elective service was not pre-authorized

• Days, service, or level of care has no concurrent authorization

• Insurer not financially responsible

• Service not covered by health plan

• Charge/procedure should have been bundled

• Untimely submission of claim


Interim Management

Innovations in the financing and delivery of hospital care are occurring at lighting speed.  A skilled interim can play a unique role in positioning the incoming revenue cycle leader for success.   Given the shortage of high-caliber, treat full-time leadership talent, clinic it takes time to replace a leader in today’s competitive environment. Finding the right fit is a process that’s too important to rush.

TCG has many years of business office experience and we can efficiently maintain and improve the performance of your patient financial services department while you search for a permanent manager.

Our experienced management professionals are on-site within two weeks of notification to manage department personnel in any or all of the following areas:

  • Admission and Registration
  • Insurance Verification
  • Charge Processing
  • Charge Description Master
  • Case Management
  • Health Information Management
  • Billing
  • Follow up and Collections
  • Payment Posting
  • Bad Debt Management

Our leader will move quickly to evaluate and assign staff to ensure optimal results during our interim management period.