Revenue Enhancement
Our revenue enhancement services are designed to increase net revenues by pinpointing areas for improvement in your organization.
Our in-depth review helps your company define revenue policies and procedures, maximize reimbursements, improve collection techniques and cash flow, and cope with regulatory and coding changes. At RSM McGladrey, we offer the following revenue enhancement services:
Medical billing
With all the pressures you face running your practice or clinic in the most efficient and profitable manner, you shouldn’t have to worry about the costs and time spent on medical billing. Our medical billing service enables you to focus on other business details and — most importantly —your patients.
We provide you with the timely and responsive service you need and the high degree of personal contact you deserve.
Outsourcing your medical billing and collection services helps you:
- Free staff to serve patients (increasing revenue)
- Avoid the process of hiring, training, retaining and supervising more staff
- Free space for revenue-generating patient service
- Avoid postage and clearing house costs
- Avoid computer hardware and software purchase, maintenance and upgrade costs
- Avoid telecommunication costs
- Relief from time-consuming patient bill inquiries
Strategic pricing
Our multifaceted MED-RATE price-setting process considers market conditions, pricing survey data, administrative and manager input, and expected additional net revenue at departmental and procedural levels. This approach is used for hospitals as well as physician services.
With MED-RATE, your organization no longer needs to make across-the-board price increases to improve net revenue. Instead, you can increase only those prices that maximize your organization’s bottom line. To create various pricing and revenue scenarios, we use historical data sorted by procedural code and assumptions based on third-party payer reimbursement methodologies. To produce a detailed revenue budget, MED-RATE anticipates changes in volume by payer within departments.
Medical group fee schedule development
As medical groups continue to have difficulties collecting what they charge, a more strategic pricing methodology is often a helpful solution. When we assist you in establishing or revising fee schedules, we consider several factors, including strategic pricing options and constraints, third-party payer reimbursement, pricing methodologies and ongoing fee schedule maintenance. Our approach is designed to develop a fee schedule that is consistent with the way payers reimburse, easy to maintain and meets the financial needs of the group.
Managed care organization negotiations
When our consultants assist with health plan negotiations, they fulfill a number of roles — from behind-the-scenes strategists to active participants. Our managed care strategy serves as a framework for evaluating all contracts, as well as developing and analyzing models based on demographics and financials. At your request, our consultants participate in health plan proposal and counter proposal sessions.
Coding analysis
Our consultants provide specific recommendations for improving the charging process and increasing the accuracy of ICD-9 and CPT-4 codes. Benefits of this include creating a more accurate picture of these codes, increasing cash flow, receiving fewer denied claims and facilitating a more exact representation of services provided to patients.
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