Healthcare revenues are generated through a complex mix of individually insignificant transactions comprised of both services and goods (pharmaceuticals, medical equipment, supplies, etc.), which are often provided by different healthcare provider types, recorded in different computer systems, and in settings that may or may not be operated independently of one another (i.e., in “silos”). To further complicate the matter, the accuracy and ultimate collectability of these revenues are entirely dependent upon the healthcare organization properly capturing all valid charges, recording to their ledgers and then coding and billing the patient or their insurance company accurately, timely and in the format prescribed by the individual paying entity, in order to attain full payment (or “reimbursement”).
The complexity doesn’t stop there. Many types of healthcare organizations must file “cost reports” each year that essentially calculate an individual paying entity’s share of the healthcare organization’s costs attributable to that entity’s covered patients (such as Medicare). These cost reports may, or may not, result in a settlement to or from the healthcare organization, depending on the type of cost report involved. The resulting settlement, if any, is a component of the total reimbursement related to the healthcare organization’s servicing of the patient covered by that insurance company or other paying entity. Failure to properly file a cost report, or inaccuracies in properly filed cost reports, often result in healthcare providers being paid less than what they are truly owed for the services and goods they provided.
The nature of the healthcare revenue cycle and its reimbursement is such that a weakness in any link of the chain can be extremely harmful to the healthcare organization’s bottom line. Worse, many healthcare organizations are not aware of errors or weaknesses in their revenue cycle, as they continue to operate each year much the same as the last, without routine consultations with experts or bringing in “new sets of eyes.”
CRI partners with healthcare providers across the South and has assisted many in improving their revenue cycle. From IT advisory, to cost reporting and billing, to a holistic consideration of the revenue cycle, our healthcare partners and team members stand ready to ensure that our healthcare clients are receiving the maximum reimbursement to which they are entitled.