Revenue Cycle Management Best Practices
SCP operates its own revenue cycle management organization to perform all coding, billing, collections, and customer functions for our 7M+ patient visits per year.
Maximized Revenue Opportunities
We have resources, policies, and procedures in place and available to optimize financial growth for our ED physician practices.
Proven Strategies & Proprietary Systems
We specifically design solutions around accurate documentation and information for more efficient revenue optimization.
Corporate Executive Oversight
The entire revenue cycle, from chart capture to tertiary collections, benefits from expert operational supervision and management.
State-of-the-Art Business Intelligence
Our solutions support physician documentation, clinical indicators, coding analytical tools, and chart delivery/processing portals.
PreBilling – More than Charts and Coding
At SCP we know that successful clinical documentation translates into quality reporting, tracking, and feedback. Good clinical documentation will improve communication, increase recognition of conditions that are responsive to treatment, validate the care that was provided, and show compliance with quality and safety guidelines.
ProCode
- Performs professional and technical coding and quality assurance audits
- Reviews and responds to any coding related denials/rejections and patient complaints
- Dedicated code and audit team focusing on MIPS measures
- Focused nurse specialists dedicated to specific clinical reviews, education and feedback.
PreBilling Operations
- Team of stateside and offshore partners to verify demographic and insurance eligibility information
- Responsible for reconciling ingestion of patients’ records and charts into billing platform
- Contributes to maintaining proper and efficient workflow through PreBill front end processes
- Daily focus on consistently maintaining inventory levels, proper chart flow and quality of work processing to PostBill
Health Information Operations Department (HiOps)
- Formerly known as the EDRC and is responsible for ED, UC, ED OBS and Inpatient response chart and log acquisition
- Remote and on-site teams acquire logs and charts
- Process the date of service charts and logs, stray charts, and quality queries
- Work with IT on CDF implementation and to ensure feeds are working correctly
PostBilling – More than Denials,
Days, and Dollars
SCP maintains Contact Centers staffed with well trained personnel who employ a variety of tools to help patients resolve payment questions or issues.
Account Receivables (A/R) Management
- Comprehensive approach to managing claims through to resolution
- Utilizing automated workflows and tools, commercial and governmental denials and underpayments are identified and appealed to maximize revenue
- Claims status and follow-up activities are managed through our task management system as well as our professional claims staff.
- All patient responsibilities and billing inquiries receive our full attention.
- Offer flexible patient engagement tools and communication channels that allow the patient to service their own account balances utilizing our patient portal and direct service assistance through our Patient Contact Center (PCC).
Bad Debt
- Uncollected balances do require debt collection services and we deploy these services to preserve revenue further.
- Accomplished through the reconciliation of accounts transferred to bad-debt.
- Maintaining the quality and customer service needed to meet our patients’ needs.
Revenue Integrity
- Oversees all governmental audit requests/medical record requests.
- Work higher-level appeals with payers (redetermination, reconsideration, and ALJ hearings).
- Research and maintain resources for governmental payer fee schedules are also completed.
Reimbursement
- Payor audits are conducted to ensure accurate reimbursement is received from governmental and contracted payers.
- Payor appeals are done based on state and federal payment requirements to recover revenue.
- Departmental management and auditing of charge masters.
Value Added Services –
Transforming People, Processes and Technology
RCS Systems
RCS Training
Client Services Management Solutions
Analytics
Project Management Office
Clinician Enrollment
Success Stories
Learn about specific challenges our hospital medicine partners faced and how SCP Health helped them see measurable results with our Documentation and Revenue Cycle Management solution.
- Success Story 1
- Success Story 2
- Success Story 3
Documentation and Revenue Cycle Management Expertise
December 08, 2021
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