Revenue Cycle Assessments
RGC Group partners with your people to apply our rigorous analytical process to your underperforming business units. We pinpoint the specific obstacles that are impeding operations and profitability, and find creative solutions to help the business move forward.
We use a variety of tools during this process, including:
- Detailed data analysis tells us the financial realities of the unit under review; we break down our findings into clear, “easy to understand” language.
- Workflow documentation of business practices, such as patient care and charge flows, that clarifies exactly what the current practice is.
- Technology review to learn whether your current technology is providing the efficiency, ease of use, and practical ROI you need. Based on what we find, we may work with you to redesign how your current technology is used or search to see if more appropriate and effective technology is available.
- Organizational assessment that reviews all personnel aspects of the business unit or units working together. In some cases, the revenue or compliance challenge holding back maximizing revenue or improving compliance is whether the right tasks are being done by the right people or roles. We assess everything from staffing levels, the leadership structure and reporting lines, to job and task descriptions and business workflows.
Using these tools and more, RGC Group consultants conduct a gap analysis and provide you with specific, actionable recommendations based on our findings. We outline a ‘future state’ scenario that solves key issues in the simplest manner possible. We keep our recommendation reports concise, clear, and attach measurable factors to the recommendations so their success can be quantified.
What happens after the analysis? Your team can take our gap analysis report and recommendations and run with them. Or, we can stay with you to lead their implementation.
Our staff are all experienced project managers who have conducted change management oversight on projects for multi-facility health systems and large provider practices, including technology implementations and organizational transition support. Often times, having a project leader outside the organization can make implementing changes easier.
If you’d like to learn more about our revenue cycle analysis process, send us a good time to call you and we can answer your questions.
“RGC Group is extraordinarily comprehensive in its revenue cycle review. From workflow review and data analysis to gap analysis and solution management. RGC’s involvement has been integral in helping us achieve success at all levels.”
David Wyman, MPA
Vice President, Administration
St. Luke’s and Roosevelt Hospitals, NY
Redesigned DRG Appeals Process Nets Additional $1.4 Million in its First Year
This organization’s appeals process for downgraded DRGs was broken. Lengthy and inefficient, it resulted in a high volume of appealable claims missing appeal deadlines and denied for being time barred. Although the organization had a 95% success rate for cases they did appeal on time, over 85% of their potential appeals were time barred.
We fixed their DRG appeals process, redesigning inter-departmental workflows so they could respond more quickly to payer DRG downgrade notices. Our process redesign reduced their time-barred DRG appeal denials rate to 15% – and brought in an additional $1.4 million in recovered cash during the first year following the transformation.
Provided Road-Map to Financial Stability for a Clinical Department
In this instance, a clinical department was struggling with high denials, reduced cash inflow, and above-average aging A/R that kept them in a financially precarious position. Hospital leadership had already taken a number of concrete steps to improve this department’s financial health. When none of these initiatives was successful, hospital leadership engaged RGC Group to bring a new perspective to their challenges and opportunities.
Leading an intensive collaboration with department administration and staff, RGC Group provided them with a detailed gap analysis and specific, actionable recommendations that linked directly back to the gaps identified. Department administration agreed that the RGC gap analysis and recommendations report offered them a clear path forward from current operational challenges toward reaching their revenue goals.
Built a 340B Compliance Audit and Scorecard Process to Protect Drug Costs
We built a process involving numerous departments for a multi-hospital system that empowers it to be pro-active about adhering to the intricate web of 340B legal compliance requirements. The audit process, worksheets, and scorecard we devised for this healthcare organization allow it to maintain the cost savings of their 340B program and will allow them to pass internal and OMIG audits in the future.