Financial Performance Improvement
Acacia Professional Services offers enterprise revenue cycle strategy consulting that addresses the set of senior management and board decisions that establish the policy guardrails for the overall business and ultimately determine its potential financial performance.
Welcome to the New Patient Centric
Enterprise Revenue Cycle
Enterprise Revenue Cycle
New paradigms are emerging from the consolidations and mergers of healthcare organizations and entities as well as standalone facilities that are aligning with physicians, home health, hospice care, and other entities within a community.
Advances in technology have created an opportunity to put the patients back in the center of healthcare finance, as well as opportunities to integrate multiple entities into one cost-effective and cost reducing revenue cycle operation. Some call it consumerism, patient centricity and various other names.
At Acacia, we call it keeping the patient at the center of everything we do and creating a Patient Centric Enterprise Revenue Cycle that transcends all entities and providers of care.
Staying Focused On the Patient Amidst Change
We are living in a new world where healthcare organizations within communities are no longer separate. From a clinical perspective, the patient is central across the continuum of care, however, consolidation efforts have left the patient out in the cold from a financial perspective.
Now the patient has 2, 3, 4 and up to 12 different billings from all of their providers of care. They get multiple EOB’s from their insurance carriers (if they have coverage) and have to get multiple authorizations. They must give the same information repeatedly for the same episode(s) of care and have to call several different places to make appointments. Everything is connected, but for the patient, it couldn’t be further apart.
Organizations do not have a personal relationship with their patients financially. They are sent them from one provider to another to obtain information or assistance. Customer relationship technology is used to engage with patients for follow up and disease management, but that same technology is not utilized from a financial perspective.
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Revenue Cycle Services
Patients today expect higher levels of service, better access to care, flexible schedules, access to more personal health information, and an active role in the care they receive and where they receive it. Various payer organizations are also encouraging and incentivizing patients to participate, pay attention, ask questions, and obtain more information in an effort to reduce the cost of care. Emerging technologies, robust electronic health records, and patient portals are raising the bar for the patient experience clinically and financially. Patients want access to value-based care, convenience, and control over their information. This is exciting and challenging because it’s time to think of the patient at the middle of the revenue cycle and that brings many sacred issues and ways of doing business into the spotlight.
Patient access services (PAS) is one of the most important elements of a patient-centric revenue cycle regardless of whether centralized or decentralized.
Patient access personnel are typically the first staff members that patients come into contact with – as they schedule and register for healthcare services.
In addition to providing the feel-good customer service that patients want, patient access staff are charged with getting information into the systems correctly. And, they are being asked to improve efficiency and quality, standardize all intake areas throughout a system and work in a closed-loop manner on denials management.
If things go wrong in patient access, you can count on being haunted by problems that cascade throughout your revenue cycle process, requiring countless hours of re-work and clean up and negatively affecting reimbursement timing and the cost to collect. Unfortunately, with PAS staff being one of the traditionally underfunded areas and highest points of turnover for hospitals and physician practices, healthcare organizations often struggle to keep these problems from recurring.
We can help. Acacia Professional Services outperforms all other consulting companies when it comes to bringing healthcare knowledge and tools and methodologies needed to solve complex organizational challenges. We can empower your healthcare organization by fine tuning and standardizing patient access operations to ensure operational efficiency through staff training, workflow redesign and standardization, and information systems optimization.
AREAS OF FOCUS IN PATIENT ACCESS SERVICES INCLUDE:
- Patient access assessment and gap analysis – decentralized vs. centralized
- Essentials in customer service excellence
- Pre-service and point-of-service financial counseling and determination of accurate financial obligations
- Enrollment and outreach for expanded assistance programs
- Scheduling efficiency and appointment utilization
- Optimization of expanded ED, outpatient and clinic access operations
- Electronic master patient index (e-MPI) best practices
- Insurance verification, eligibility and authorization management
- Observation services
- Data capture and quality control
- Bed management and throughput
- Performance benchmarking and monitoring (dashboards)
Is your Health Information Management (HIM) department accountable to their new roles in advanced EHR utilization while simultaneously bridging the gap to the continuum of care?
A siloed HIM department results in delayed cash, increased denials, rework, and loss of revenue. The advent of the EHR has changed the role of Health Information Management. And, in most organizations, HIM has not caught up to the changing tides.
HIM, like care management, serves as a secondary clinical bridge for the revenue cycle especially when considering the quality and depth of physician documentation and clinical documentation improvement (CDI) programs to support defensible and transparent patient care. In addition, as one of the pillars of the patient-centric revenue cycle, HIM plays a central role in coding, EHR and ELR (legal record) management, denials management, appeals, DNFB management, and compliance. With the pace of accelerating regulatory changes, thoughtful HIM leaders are reengineering work processes, improving automation, and championing the patient-centric revenue cycle not only in their own departments but across the clinical continuum of care.
If your organization’s HIM professionals fail to adapt to these changes, you can limit the availability of important clinical information, increase audit risks, cause coding backlogs, and ultimately reduce reimbursement.
We ensure your success with our industry leading knowledge and methodologies to the table.
Acacia is a leading provider of Health Information Management services such as:
- HIM assessment and gap analysis
- DNFB strategic management
- Clinical documentation improvement (CDI) training and audits
- ICD-10 coding audits
- Interim coding services (outpatient and inpatient)
- EHR/ELR standardization
- Interim HIM management
- Core HCIS utilization enhancement and automation
Learn more about how Acacia clients have de-siloed their HIM departments, accelerated billing, and increased revenue.
A patient-centric revenue cycle is built on a variety of pillars. When there’s a crack in any of these pillars, the foundation begins to crumble – or worse yet, falls down.
When this happens, patient financial services (PFS) is often left to sort the rubble. And, this typically involves hours upon hours spent reworking accounts and then attempting to get claims submitted for payment.
The problem with this all-too-common turn of events? The passionate experts in PFS spend many hours simply cleaning up messes – which could have been prevented in the first place. As such, not much time or energy is spent where it needs to be – which is battling the payers for every penny owed to the organization.
The time for change is now. Healthcare organizations cannot afford to chase problems after they occur – they need to proactively prevent them. Changing from a reactionary revenue cycle to a proactive one involves a variety of components such as:
- Automating billing
- Migrating accountability of claim requirements to the front and mid-cycles
- Automating collections
- Focusing on denials and underpayment management
- Emphasizing customer service and consumerism
With a proactive approach, you will have the time to focus attention where it counts – on a metric-managed revenue cycle.
Acacia Professional Services is here to support your cultural and technological shift to a proactive patient-centric clinical revenue cycle through our patient financial services consulting. With our pillars methodology, critical metrics, and our underlying methodologies within PFS, we can support the following:
- Business office assessments and gap analysis:
- Underpayment and accounts receivable cash acceleration roadmap
- Denials management and reimbursement management
- Cash management
- Clearinghouse and other vendor improvements
- Vendor management
- Customer service
- Process-based training & education
- Interim PFS leadership and staff augmentation
As margins dwindle and financial pressures escalate, healthcare organizations are under more pressure than ever before to maximize their expected reimbursement.
Are you confident that your organization is capturing 100% of the charges for all services rendered via a revenue integrity program? Often organizations think they’re solving revenue integrity by staffing a CDM coordinator. While the function of a CDM coordinator is critical, what is often overlooked is a revenue integrity program integrated to clinical care delivery that maximizes gross revenue compliance in alignment with clinical documentation.
Whether your organization is converting to a new electronic health record (EHR), recovering post implementation, or operating in a stable environment, it is fiscally critical to ensure revenue integrity is at its maximum potential.
At Acacia, we combine the art of revenue integrity with the science of CDM maintenance to deliver a fully defensible and sustainable product of 100% gross revenue accountability that aligns to generate income. We’re confident that we have what it takes to help your reach optimal levels of reimbursement.
“What sets Acacia apart is they understand how the revenue cycle works for a hospital and how to work our particular EMR to best meet those needs.”
Discover how we can help your healthcare organization improve its financial performance with any of the following services:
- Revenue integrity assessment and gap analysis for net revenue realization opportunities
- Chart-to-charge audits: reviewing defensibility of charges or missing charges
- Revenue Integrity audits – departmental interviews & observations to identify charge capture risk and opportunity
- Implementation of revenue integrity program
- Establishment of gross revenue accountability targeting compliance risks and possible audit targets
- Late charge & charge rejection mitigation and management
- Revenue integrity KPI establishment
- Sustainable capture of all previously lost revenue
- P&P’s for CDM management and charging guidelines
- CDM Review
- Line item review compared to R&U
- Pricing review
- CPT/HCPC/State specific coding review
- Descriptor review (in comparison to AMA regulations)
- Identification of missing, obsolete, updated, or deleted codes
What is an
Advances in technology have created an opportunity to put our patients back in the center of healthcare finance, as well as opportunities to integrate multiple entities into one cost-effective and cost reducing revenue cycle operation. Some call it consumerism, patient centricity and various other names, we call it keeping the patient at the center of everything we do and creating a Patient Centric Enterprise Revenue Cycle that transcends all entities and providers of care.
Health Information Management
The Future of the Patient Experience
New tools and technologies provide the opportunity to create an enterprise revenue cycle. These new tools together with standardization and streamlined workflows can guide patients’ financial interactions as well as maximize productivity and efficiency, thus reducing overall costs.
The journey starts with the very first interaction, that first phone call that a patient is ill and needs service or is engaging with us for preventative care. If care delivery is connected, organizations can likewise connect the financial tasks and activities, building trust with their patients from this very first interaction; from scheduling appointments to managing an entire episode of care and the payment of that care.
Organizations can focus on the path to the better outcomes and higher quality of care with engagement and support for them financially.
Reimagining the Patient's Perspective
Acacia Professional Services has a vision for connected and collaborative patient care. Let’s say the patient needs care or needs a wellness visit. They call one phone number or visit one website and are immediately connected to one person who is there to guide them either on the phone or through technology. They can schedule with a primary care provider as a first stop, then call the same number or visit the same website to connect that visit to a laboratory for testing, a radiology department for images or x-rays, an outpatient surgery site or specialist. That same first entry point connects them for a medical device need or home health care.
All of these entities are within your network of providers. They are able to give their demographic and insurance information only one time and it is shared across all entities. They obtain the costs to make choices and out of pocket expenses are presented as well. They need multiple authorizations based on their payer but in this one call those authorizations are identified and obtained.
Acacia Point of View on Financial Improvement
Whether you are just beginning your journey toward a patient centric enterprise journey, or have completed several steps along the way, Acacia will help your organization achieve your goals.
With over 20 years of revenue cycle optimization experience, Acacia Professional Services has helped clients realize sustainable and superior results.