Revenue Cycle Management

Revenue Cycle Management

At MRI, our revenue cycle consulting services are designed to develop greater efficiencies around key processes, critical thinking, cash flow and controls that materially impact performance. Learn more about the importance of revenue cycle optimization, MRI’s revenue cycle services as well as our revenue performance improvement services.

Our revenue cycle services include:

  • Current performance gap assessment
  • Key performance indicator summaries comparing current performance against industry standards
  • Technology optimization
  • Cost assessment impacting margins
  • Executive summary presentations to leadership
  • Data-driven revenue cycle

We've optimized revenue cycle for many of our health care clients. Learn how we did it.

Revenue Integrity Services

The U.S. health care industry is currently undergoing monumental changes as a result of health care reform. Organizations are required to move away from a utilization- based health care system to a patient-centric, outcomes- based health care structure. As a result of this transition to patient-centric care, organizations will continue to see further scrutiny on coding compliance, which will be used to support the payers’ ability to monitor an outcomes-based system. Additionally, organizations will continue to see declining net revenues associated with the traditional utilization-based system, as financial performance will be directly linked to care outcomes. Coding compliance and declining net revenues are not new to organizations; however, in both the pre- and post-health care reform environment, both take on renewed importance to the financial profitability and sustainability of health care organizations.

How can we help?

At MRI, our revenue integrity services are designed to support providers with coding compliance, claims management and price setting methodology while protecting gross and net revenue streams along with adherence to contractual obligations.

Ce Within coding compliance, our solutions support inpatient (DRG/ ICD10), outpatient (CPT/ HCPCS), coding and charging accuracy. Charge description master (CDM) maintenance and updates ensure compliance with regulatory guidelines and principles. Chart and claims reviews to validate coding and documentation accuracy. Since coding has a direct correlation to gross and net revenue, our primary goal is to ensure compliance, accuracy and financial opportunity

In the middle, our revenue integrity solutions address claims management. Since we understand the up-front (dropping a timely clean claim in the business office) and back-end (financial reimbursement and contractual), we are able to use chart and claim testing reviews to provide coding guidance, process improvement, education and financial impact solutions to your claims management.

Within price setting, our solutions support market competitiveness, service level cost analysis or development and net revenue identification. We work with our clients to evaluate their current price setting methodologies (general procedures, supplies, pharmaceuticals) and improve their CDM procedure-level pricing for services while maximizing financial opportunities (cost management and reimbursement) from the supplies and payers.

Coding Compliance

    Charge description master review

    Charge capture review

    Chart review

    ICDIO assessments and translation Coding education

Claims Management

    Claims Reviews - testing includes:

    Eligibility - member and provider Benefit level

    Coding sample

    Reimbursement

Pricing

    Market assessments

    Price setting methodologies for general procedures, supplies and pharmaceuticals

    Cost, Market and Strategic-based pricing

    Gross and net revenue modeling


Your Benefits

Led by specialists with a deep understanding of health care reform compliance and industry needs, our RSM team provides clients the following under the revenue integrity services umbrella
  • Coding compliance to Medicare's billing standards and requirements
  • Coding that accurately reflects the level of care being provided to patients, which directly leads to increased charge capture and net revenues
  • Pricing for services that are reflective of both the level of care being provided, along with the cost of providing such care
  • Understanding market competitiveness and ability to increase prices within reasonable levels, while managing consumer concerns
  • Financial and contractual management to support and protect net revenue stream beyond Medicare, but also extended to the private payor environment.
  • Increased net revenues to the bottom line

Can revenue integrity services help your organization?

If these questions resonate with your organization, our team can help. Contact us today.

    When was the last time your organization conducted either a coding compliance, claims review or pricing review?

    As you enter into your budget period, have you considered the many coding changes that will impact your net revenue goingforward?

    Do you have compliance concerns related to the accuracy of your coding?

    Are your claims submitted to your payers capturing all services performed?

    Areclaims being correctly reimbursed based on your negotiated contractual terms?

    Are your prices reflective of your position in the market, or do you have opportunity to be more competitive?

    Are the costs associated with providing services reflective in your current prices and price-setting methodology?

    Do you have contractual opportunities to gain net revenue based on the appropriate pricing of strategic services?

    With significant decline in reimbursement payments and ongoing margin pressure, the need for revenue cycle optimization to align people, process and technology becomes increasingly vital to the sustainability of health care organizations.




Revenue Performance Improvement Services

At MRI, our revenue performance improvement services are designed to develop greater efficiencies oround critical processes, critical thinking, cosh How and controls that materially impact performance. As of result of our qualitative and quantitative approaches, we are able to clearly and accurately identify critical issues, roodblocks and inefficiencies thot ore impeding optimal performance for health care organizations. We develop revenue cycle and performance solutions ond execute value-added strategic initiatives designed to resolve challenges and facilitate improved performance. Our services focus on your organization's front-end, middie ‘ond back-end operations. the following provides a snapshot of our service offerings ond value to our clients.



Patient access



Scheduling
processes



Pre-registration
processes



Registration
processes



Paint-of-service
colections



Bad debt flags



Financialcounselling/
prior balance
adjudication

Staffing deployment
Front-END

Dental management


Denial
quantification



Denial tracking


Denial mgt.
program



Insurance
verification



Pre-certification/
authorization


Charge capture
and pricing


Managed care
pricing/contracting



Charge capture
reconcilation



Late charges



Resource-
based pricing



Formula- based
pricing




CDM review



Pricing
rationalization



CDM stadardization/
consolidation
MIDDLE

HIM medicale
documentation


Clinical
documentation



Outpatient
documentation



Medical records assembly process


Coding and
3rd party relmbursement


ICD-9 and
ICD-10 coding



HCPCS coding



APC process
improvement



Cost report
optimization



.DSH IME/GME
.Medicare bad debt

.Excluded units
.wage index
.Transfer DRG


Physician coding

Observation
status review



Fee screen review


Claims processing and denial management

Late charge analysis


EDI editing and billing


Denials and appeals tracking

Staffing model


Billing system backing (DNFB reduction)

Electronic billing



volidation


Unit billing


DNFB reduction
BACK-END

Cash collection and AR management


Receivable strategy and work tools

Bad debt management,including medicare


Denial management



Self-pay collection management


Agency/ vendor management


Payer appeal/ dispute resolution Mg'd care prompt pay penalties and underpayment recoveries

Cash acceleration


Third party follow-up


Electronic remittance/ payment postings
Value
  • Efficient processes to control financial risk
  • Improved accuracy of collected data
  • Improved POS collections
  • Reduction of denials due to registration issues
Value
  • Improved net revenue from pricing bades on market, payer mix, service level and objective charge structure and formulas
  • Improve charge capture processes
Value
  • Improved net revenue from pricing bades on market, payer mix, service level and objective charge structure and formulas
  • Improve charge capture processes

Outsource Your Medical Billing and Coding

MRI is a full service billing company providing services to a wide range of medical specialties. We employ only experienced billing professionals. By relying on our highly trained medical billing 3staff, you can maximize your practice's efficiency, and dramatically lower its expenses. Services include:

Provider contracting & credentialing
Insurance verification & patient eligibility
Prior Authorization
Clean claims submission
Payment posting
Accounts receivable follow up
Patient collections
Practice management & education
Consulting
Seasoned billers & coders
Preauthorization & insurance eligibility service/support
Plus More!

With our experience in medical billing, we deliver results that will help grow your practice.

Our comprehensive medical billing services allow you to focus on what you do best—treat your patients. Whether you have practiced medicine for years or you're a new physician, we offer the support you need to navigate the changing healthcare laws, manage your practice, and much more.

We work in close communication with the staff of each client, and integrate ourselves into the daily operation of their practice which leads to industry-leading profitability and personal customer care.

EMR / EHR Consulting

EMR Consulting That Will Revolutionize Your Medical Practice

As a physician, your ability to deliver outstanding health care services depends on having reliable, secure, and fast access to your patient records. You don’t have time to wait for charts or medical history to load; you need to have a system in place that ensures you can help the maximum number of patients while giving them the best possible experience.

Our experience in the healthcare IT field can make sure you have the IT solutions in place for your practice so that your organization is positioned to reach its goals. Each EMR implementation consultant will work with your practice to understand your needs and deliver solutions tailored to meet them. And beyond our technology expertise, you’ll benefit from our extensive consulting on a wide range of EMR-related topics such as workflow optimization, clinical content, practice efficiency, HIPAA compliance, and improving patient engagement.

    1000+
    Over 1000 EHR projects completed over 14 years.
    60%
    Over 60% reduction of IT issues after just 4 months.
    2X

EHRs optimized by MRI are over two times faster than industry average.

EHR Consulting: Save Time With Fast Access to Your Patient Records

Tired of waiting to access patient charts? Does a slow system mean you’re struggling to keep up with your daily workloads?

Make sure that your system’s performance is reviewed to guarantee you aren’t wasting time. With a fully-optimized system, you’ll not only have faster access to your EMR/EHR health records and patient histories – but your team members will have all the tools they need to perform the critical administrative functions that are the key to a thriving practice. Because at the end of the day, slow or unreliable computing response times will reduce the performance of your entire staff.

Benefits of EHR Consulting: Put an End to Slow and Lagging System Performance

    Access your electronic health records quickly

    Eliminate non-performing workflows

    Put an end to slow chart retrievals

    Enjoy fast response times and system logins

    Ensure the patient data you need is there when you need it

Serve More Patients And Improve Their Experiences

Our EHR consulting experts do more than just advise you on IT matters; we’re also experts when it comes to practice efficiency. Our experience helping medical organizations ensure they have the more efficient processes means you’ll be able to see more patients, care for them faster, and give them the best possible patient experience.

You’ll be able to reduce your time to chart, schedule visits more efficiently, and maximize the amount of engagement with each patient.

Improve Your Care Delivery and Practice Efficiency

    Streamline your clinical workflows

    Boost patient engagement and experience

    See more patients

    Reduce physician clinical hours

Does Your Technology Meet Your Needs?

Are you frustrated with your current system? Have you determined that it doesn’t meet your needs, but you don’t know how or where to start?

But you also need more than just a computing infrastructure – it needs to work seamlessly with your administrative and EHR applications. Fortunately, our extensive experience successfully implementing the most popular platforms – including GE Centricity EMR, Aprima, NextGen EMR , Allscripts, eClinicalworks, Intergy, Greenway, and Practice Partners – means that the software you depend on will integrate flawlessly into your workflows.

MRI can advise you on the optimal technology infrastructure for your healthcare organization. Our EMR implementation specialists help you to put an IT network in place tailored to your specific needs so you’ll be well positioned to concentrate on what you do best – deliver outstanding health care.

EHR Consulting: Ensure Your Systems Meet Your Needs

    Complete assessments of your existing computing

    Discover why your existing system doesn’t serve your needs

    Guidance on system replacements and upgrades

    Get the most out of your EMR/EHR software

Enjoy Peace of Mind That Your Data is Secure

Having a fully HIPAA- and HL7-compliant technology partner will ensure you remain ahead of the curve in safely managing your patients’ electronic medical records.

With our experience in medical billing, we deliver results that will help grow your practice.

Our comprehensive medical billing services allow you to focus on what you do best—treat your patients. Whether you have practiced medicine for years or you're a new physician, we offer the support you need to navigate the changing healthcare laws, manage your practice, and much more.

We work in close communication with the staff of each client, and integrate ourselves into the daily operation of their practice which leads to industry-leading profitability and personal customer care.