Healthcare

Health Systems

Revenue Cycle

Revenue Cycle Solutions for Health Systems

In the face of growing financial pressures and changing legislative requirements, hospitals, health systems, and physician practices must manage increasing financial pressures and changing legislative requirements. They need to control operating costs, while providing high-quality care to the communities they serve. Increasingly, providers are recognizing that they can only achieve this with effective revenue cycle management. 

Navigant identifies opportunities and provides tailored revenue cycle solutions to create a clear infrastructure and a team-based culture for optimal revenue. Our team works collectively with physicians and hospital revenue cycle teams—providing staff with needed support before, during, and after implementation—to ensure they achieve sustainable results. We bring deep experience and best practices to revenue cycle enhancement initiatives.

Performance Improvement

Healthcare providers are challenged to keep up with the demands of today’s changing healthcare environment. Long-term payer trends and changing reimbursement structures are driving patient care to low-cost settings, and consumer demands are leading a comprehensive redesign of how care is accessed and delivered. To succeed, organizations are focusing on performance improvement—a planned, systematic, organization-wide approach to process design and performance measurement, analysis, and improvement.

Navigant’s performance improvement team includes physicians and executives with extensive management experience, as well as Baldrige, Lean Six Sigma and performance excellence specialists. Our consultants have experience in the day-to-day operations of healthcare organizations and understand the specific challenges and issues associated with operating in today’s healthcare market. 

We focus on a wide range of areas, including management, operations, patient care, programs/services, clinical resource management, finance and revenue cycle, managed care, strategy and market, information systems, and governance. Additionally, we provide clients with implementation plans that outline benchmarks and timetables to encourage immediate action. 

Solutions:

Revenue Management
We enhance performance and patient satisfaction through assessment, redesign, and comprehensive management of revenue cycle.

Revenue Integrity
We design and implement processes to monitor revenue and identify, correct, and optimize the processes and systems that lead to lost revenue.

ICD-10 Solutions
We provide guidance on ICD-10 and the implementation of ICD-10 solutions.

Clinical Documentation Improvement Services
We support providers with tools and innovative educational programs that foster complete and accurate clinical documentation. 

GPS Health: Revenue Cycle Workflow and Analytics
We offer a web-based, revenue cycle workflow and reporting tool that combines leading industry experience and results-oriented technology.

EMR System Selection
We conduct due diligence around current state technology platforms, evaluation of market offerings for primary EMR systems and bolt-on tools, cost evaluation, and implementation preparation.

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EHR Optimization

Navigant Consulting’s acquisition of McKinnis Consulting Services (MCS) in December 2015 added another level of revenue cycle management expertise to Navigant’s already robust service offerings. MCS has a proven track record of helping clients realize returns on investments related to Epic revenue cycle system conversion. Our professionals leverage experience and best-practice revenue cycle strategies in all phases of system adoption, from platform selection through post-live optimization. 

In making the choice to adopt a next-generation electronic health record (EHR) platform, healthcare systems are not only updating software, but undergoing a complete operational reconfiguration. Unless carefully managed, revenue losses can plague these implementations after they go live. Navigant helps providers ensure their EHR implementation is successful.  

We help our clients prepare for conversion with a defined methodology to identify key stakeholders and establish a collaborative communication structure that bridges the gap between operations, IT, and clinical departments. We help organizations align their financial processes for EHR success, such as charge generation, revenue reconciliation, clinical and patient access revenue cycle integration, discharge management, claims submission, account follow-up, payment posting, and denial and metric management. We offer industry-leading results to help organizations sustain business viability. We even put a portion of our fees at risk to ensure your value proposition. 

Solutions:

  • Employ a defined methodology to identify key stakeholders
  • Create a collaborative communication structure
  • Identify root causes through analysis
  • Determine key performance thresholds 
  • Break or fix issue identification, scoring, and prioritization
  • Assess and manage optimization opportunities
  • Manage system upgrades 
  • Provide regular and structured organizational awareness and education
  • Coordinate sustainable change management processes
  • Leverage technology capabilities
  • Revenue Guardian 
  • Provide emerging content management services

Learn more about the revenue cycle solutions McKinnis Consulting Services brings to Navigant. Read more about our A/R System Conversion Solution.
 

 

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Modular Revenue Cycle Management Solutions

Today’s era of healthcare reform demands new levels of collaboration to improve revenue cycle performance. At a time when change has become a perpetual mainstay, one thing has remained consistent – the need to maximize revenue while maintaining exceptional levels of care quality and patient satisfaction. In partnership with our team at Navigant Cymetrix, we help hospitals, health systems and physician practices improve performance, reduce costs to collect, and achieve sustained results with solutions tailored to each client. Our team of experienced healthcare experts benchmark key performance indicators, and help providers streamline processes, drive performance improvement, and manage change.

An effective revenue management program must promote accurate and timely capture of patient revenue, including rapid resolution of pending revenue, while providing a forum for communication and escalation of charge entry or other charging related issues. Doing so can help hospitals and health systems: 

  • Reduce variability in gross revenue capture 
  • Improve visibility around charging issues and opportunities
  • Increase accountability around gross revenue capture and understanding across the organization
  • Reduce late, missing and/or inaccurate charges
  • Minimize denials and write-offs
  • Improve net revenue capture

Solutions:

Revenue Cycle Management Solutions - Hospitals and Health Systems
Combine and tailor individual solutions to meet your performance goals.

Net Revenue Improvement

The core mission within our revenue cycle management solution model is to improve client’s revenue cycle processes and net revenue yield by leveraging electronic medical record (EMR) technology and best-practice operational strategies. By leveraging our industry expertise, strategic partnerships, and technology, we drive financial improvement and operational excellence positioning our clients to deliver the highest quality of care. We deliver lasting, impactful results through our culture of continuous collaboration and willingness to challenge ourselves and our clients to improve the overall financial sustainability of healthcare.

System Conversion and System Integration Management

An electronic health record (EHR) is much more than a clinical tool – it also automates part of the revenue cycle. EHRs contain all of the touchpoints and data elements to ensure payment, including registration, insurance eligibility, authorization, revenue capture, coding and claim scrubbing. With an effective EHR system, as a clinician documents care that’s delivered, charge capture takes place automatically in the background. This can allow for:

  • Application of diagnoses for rapid claim generation with minimal back-end review and clinician follow-up
  • Automation of payer specific claim manipulations to reduce scrubber errors and denials  
  • Automatic (instead of manual) processing and review of late charges  
  • Routing of denials to departments causing the error, improving front-end education opportunities by driving accountability

Revenue Integrity

Developing a high-performing revenue integrity (RI) department is likely to be one of a health system’s most important revenue management efforts, especially during an EHR transition and into the shift to value-based reimbursement. 

The objective of a RI department is to identify, correct, and optimize the processes and systems that can lead to lost revenue opportunities. This includes ensuring procedures, items, and services are documented, captured, billed, and paid according to the terms of regulators and payers.

Operational Redesign

Operational Redesign initiatives aim to enhance organizational structure and processes through targeted system and process optimization. With a focus on process redesign and improvement, we lead the conversion of organization structure and staffing, policies and procedures, and billing system workflows. In partnership with our clients, we document operational staffing levels, structure, processes, and workflows to evaluate and provide recommendations for any future state conversion from the current operational structure to a more tailored model. We work closely with our clients to develop best-practice revenue cycle tools, system configuration updates, and supporting processes that coincide with the operational goals of the health system.

Net Revenue Improvement

The core mission within our revenue cycle management solution model is to improve client’s revenue cycle processes and net revenue yield by leveraging EMR technology and best-practice operational strategies. By leveraging our industry expertise, strategic partnerships, and technology, we drive financial improvement and operational excellence positioning our clients to deliver the highest quality of care. We deliver lasting, impactful results through our culture of continuous collaboration and willingness to challenge ourselves and our clients to improve the overall financial sustainability of healthcare.

 
Revenue Cycle Management Solutions - Physician Practices
Close the gap between care and reimbursement.

Deploying a high-performing revenue management program continues to be a necessity for providers to survive and thrive during healthcare’s transformation. As a leading comprehensive revenue cycle management solutions provider, Navigant’s subsidiary, Navigant Cymetrix, is recognized with industry accolades such as the 2017 KLAS Category Leader Award for revenue cycle outsourcing, as well as the 2015/2016, 2013, and 2012 Best in KLAS Award for extended business office services. Navigant Cymetrix is also one of only five firms recognized as MAP Keys Compliant by the Healthcare Financial Management Association

Learn more about Navigant Cymetrix

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david zito

David P. Zito

Managing Director

Healthcare Practice Leader

+1.312.583.5871
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