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CPI Experts - Services

Operational Process Advantage™

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With diminishing revenue system wide, hospitals are under greater pressure than ever to maintain accuracy and effectiveness at every point in the revenue cycle. Your hospital may have hundreds of points throughout the organization where data are being captured that ultimately reflect on the patient's bill. And with so many areas under different management purviews, maintaining the accuracy, validity, timeliness, and completeness of data for each patient bill is a monumental challenge. Perform a self assessment >

While automated information systems and specialized coding tools bring the hospital a long way, many hospitals still find that small “disconnects” are straining the revenue cycle. At CPI Experts, our singular focus on charge process improvement allows us to apply a painstaking review of your revenue cycle while your organization keeps its focus on the business of healthcare. Operational Process Advantage™ is a comprehensive assessment of all the moving parts of the revenue cycle—from patient access to zero bill. This objective, 360-degree view will help your organization to understand exactly how you are performing against industry benchmarks, and specifically where changes in process or technology will improve your operations.

The CPI approach involves our experts’ getting in the trenches with your professionals to experience first hand the challenges your professionals face. We will examine not only the operations of coders and billers, but also evaluate the documentation and interfaces that flow from clinical departments. As a result, we help you tighten the flow of information to minimize errors and lost charges and help establish guidelines and procedures that will maintain performance in the future.

The key to Operational Process Advantage is our deep-dive evaluation of people, process, technology, and data throughout the revenue cycle. In this way, we explore the complex dependencies between clinical care documentation and reimbursement information to ensure effective processing of patient bills. We will identify the greatest opportunities for improvement in the registration, charge capture, order entry, billing, and collections areas. This allows the organization to address the issues with highest dollar impact and plan for future initiatives as cash flow and income improve. More information >

Operational Process Advantage™ -
Charge process improvement for the revenue cycle

 

People

Process

Technology

Data

Health Information Management

Reporting relationships provide appropriate control and authority

Coders maintain CPEs and certification

Staffing levels prevent backlogs

Turnover planned and managed effectively

Performance meets established industry benchmarks

HIPAA-compliant storage, retrieval, and release of records

Physicians incorporated into denial management

Priorities established for workflow management

Quality-control audits planned and implemented

Physicians use remote access and e-signature

Integrated online DRG and APC groupers

Online or voice recognition transcription system

Online tools for chart management, imaging, and abstracting

Complete capture of data and documentation at the point of care

Performance benchmarks established

Monthly and quarterly reporting established

Charge Entry and Protection

Reporting relationships and job descriptions reflect revenue accountability

Establish a program of “charge awareness” with clinical departments

CDM reviewed annually with clinical departments

Know and document CDM change management process

Charge data flow reliably from all points of service to the claim

Online order entry system

Interfaces provide reliable flow of activities from patient care to billing and claims

CDM complies with all structure, coding, pricing, and mapping regulations

HCPCS/CPT changes implemented by January each year

Line item descriptions follow bundling and unbundling standards

Charge tickets and order entry items map to service codes accurately

Billing and Claims Submission

Staffing and turnover are optimized to prevent billing backlogs

Incentives are performance-based

Billers are cross-trained in multiple payer types

Online tools maximize biller productivity

Performance is managed to industry benchmarks

Billers are trained annually in Medicare compliance

Systems generate biller worklists

Integration between patient financial system and billing

Daily downloads are automatic from PFS system

Clinical department-specific error reporting

Biller-specific productivity and error reporting