Operational Assessment

Your 21st Century Solution to Gaining & Maintaining Strong Revenue Cycle Performance

OPERATIONAL ASSESSMENT

Operational assessment for the purposes of developing a management action plan to address process improvement and increase efficiencies. 

Patient Access

1. Operational Assessment covers:  

   • Scheduling Services

   • Pre-registration and Registration

   • Preauthorization/Pre-certification

   • Letters of Non-Coverage/ABN

   • Advanced Beneficiary Notice   

   • Establishing Patient Financial Responsibility

   • Evaluate Medicaid Eligibility

   • Evaluate Liens/Liability/Cobra option

   • Benefit Verification and Authorization

   • Registration - data accuracy

   • Patient Type - Inpatient vs OBS

   • Patient Transfers    

   • Census Verification

   • Bed Control/Census

   • Revenue supported by charting

   • Patient Discharges

   • Pre-registration collections

   • In-house receivable and collections   

   • Discharged receivable and collections

2. Identify/Implement Restructuring Initiatives

3. Develop Job Descriptions and Performance Measures

4. Develop Policies and Procedures

5. Train Staff

6. Implement Staff Reassignments

7. Operational Analysis of expenses

8. Outsourcing Evaluation

9. Analysis and Reduction of Bad Debt 

Patient Financial Services

1. Operational Assessment covering:

   • AR Management and Measurements

   • In House Receivable

   • DNFB Unbilled Receivable                                    

   • Billed Receivable

   • Account Management

   • Account Revisions

   • Bill Production

   • Claim Editing

   • Electronic Data Interchange

   • Insurance Collector Work File

   • Collector Work Files

   • Private Pay Collections

   • Account Transactions   

   • Bad Debt Account Management

   • Quality Assurance Tracking

   • System Master File Review

   • Forms Review

   • Reports Review

2. Identify/Implement Restructuring Initiatives

3. Develop Job Descriptions and Performance Measures

4. Develop Policies and Procedures

5. Train Staff and

6. Implement Staff Reassignments

7. Operational Analysis of expenses

8. Early Out or Outsourcing Evaluation

9. Analysis and Reduction of Bad Debt 

Key Benefits

1. Conduct full or partial assessments within Revenue Cycle Areas with regard to current processes and operational inefficiencies

2. Identify process changes that will enhance operational efficiencies

3. Facilitate operational changes to gain efficiencies   

4. Establish performance monitoring to insure efficiencies

5. Identify job skills that can be enhanced to promote resource maximization

6. Identify tools that can be used to enhance operations

7. Identify and focus on ways to increase cash flow

8. Decrease lost reimbursement from incomplete or untimely pre-certification and or authorizations.

9. Facilitate compliant third party billing

10. Facilitate maximum reimbursement based on contract terms

11. Improve workflows and eliminate unnecessary tasks 

12. Reduce Bad Debts