RCM Audit details

ScriptsIT will evaluate and analyze your current revenue cycle operations and focus on ways to improve case management and collection. In diagnostic laboratory cases, revenue cycle management problems rarely stem from a single source. They are most often the result of many different deficiencies. Some of these deficiencies include:

  • Inadequate physician compliance
  • Staff errors due to inadequate education and training
  • Inefficient workflow management
  • Poor case management of denied claims
  • Improper application of the ever-changing healthcare laws and the policies of the payers.

Each deficiency must be addressed as part of a coordinated solution to obtain a significant improvement. 

Our initial Revenue Cycle Assessment will include establishing baseline measurements of your revenue cycle performance.  Experienced Revenue Cycle attorneys and consultants will gather the information necessary to complete our initial assessment.  We will start by having in-depth discussions with senior management to understand concerns and establish program objectives. Next, we will perform a customized review of operations, including interviews with key management personnel. Senior ScriptsIT staff will then perform a detailed audit.

Here are just a few things that we will do during our detailed audit: 

  • Coding/Billing Review
  • Review of Payer Agreements
  • Review of Problem Payers
  • Detailed Analysis and Review of Old A/R (31 days – 360 days)
  • Laboratory Compliance Review related to Federal and State Regulations

We will also address the following medical necessity issues:

  • Physician compliance
  • Requisition Forms
  • ICD-10 usage
  • Patient Medical Records
  • Letters of Medical Necessity
  • Prior Authorization Processes

After our initial assessment of your process, we will let you know how your current system is working and identify opportunities for improvement of your overall revenue operations. We 

will also provide recommendations for the creation, implementation and monitoring of workable solutions.  All assessment findings and recommendations are presented to senior management to ensure that all related questions are answered and priority of work is established. A detailed work plan is then developed with the identification of specific tasks required for successful implementation of all assessment recommendations. For example, after our initial audit, we anticipate that we will perform the following:

  • Immediately implement new processes to fix current problems
  • Immediately work on settling and collecting as much old A/R as possible 
  • Work with certain problem payers and determine why there are consistent non-payments
  • Establish favorable contractual relationships where needed
  • Aggressively correct any medical necessity issues
  • Ensure compliance with the federal and state statutes
  • Apply current statutes and case Law to all of the above

In conclusion, we look forward to serving you by:

  • Recovering revenue on old A/R
  • Reducing the number of days A/R is outstanding
  • Ensuring your compliance with federal and state regulations 
  • Reducing the volume of claim denials
  • Decreasing write-offs
  • Increasing your cash flow
  • Maximizing insurance payer reimbursements.