Revenue Management Services
The process of securing reimbursement for healthcare services is an inexact science. In a world of constantly changing payment rules, system issues often stem from missing or incorrect information residing in the patient’s insurance information, in the medical record, or on the billing claim form. Third party denials can reach upwards of 30-40%, creating a serious impact on providers’ cash flow.
SITC Revenue Management works with healthcare providers to improve the system and enhance the quality of the patient accounting and healthcare record systems so that all data are captured and all rendered services are documented.
One way to improve systems is through an internal audit. These audits compare the bill with healthcare records, logs, and other provider documentation. The auditor should be someone who, according to the "National Health Care Billing Audit Guidelines," has "appropriate knowledge, experience, and/or expertise in a number of areas of health care", including, but not limited, to the following areas:
- Format and content of the health record, as well as other forms of medical/clinical documentation;
- Generally accepted auditing principles and practices, as they may apply to billing audits;
- Coding;
- Billing claims form, including the UB-92, the HCFA 1500, charging and billing procedures;
- All state and Federal regulations concerning the use, disclosure, and confidentiality of all patient records; and
- Specific clinical knowledge.
Busy, overworked office staff may not possess the expertise required for such audits. Thus, SITC Revenue Management fills a need that the provider cannot fill. SITC recognizes that if there are problems in a provider's billing system, then services that have already been billed may not reflect all of the charges (and credits) that should have been present. SITC’s previous revenue recovery experience gives it the ability to identify lost charges and ensure that they are billed to the proper third party. The firm's incentive is directly related to the amount recovered for the provider.
SITC Revenue Management© offers a free trial audit of the provider to determine if there is a problem at the provider site significant enough to justify the engagement of an auditor for revenue recovery purposes. The trial audit also allows the provider to gauge the internal costs of such an audit (e.g., clerical time, staff support, and housing).
Revenue Recovery
Many agencies have unknowingly lost thousands of dollars in third party payments. Incorrect billing codes, claims sent to the wrong payer, or failure to meet documentation requests on a timely basis can all result in significant payment losses.
Fortunately, your agency may recover lost payments if identified in a timely manner. SITC has helped numerous agencies identify and recover thousands of dollars in payments and can train your staff on strategies and techniques to reduce future losses.
Our services include:
- Identify recoverable payments in a timely and efficient manner
- Assist in recovering lost payments
- Identify billing practices leading to potential payment inaccuracies
- Provide tools and training for both billing and clinical staff members to improve billing compliance and payment accuracy and avoid future losses
Our Qualified Staff includes:
- Registered Nurses, Physicians, Attorneys and other Healthcare Professionals
- Experience in Medicare, Medicaid and other third party payers’ medical review and appeals processes
For additional information, please contact us.