Reimbursement

Operating and managing a health care organization in today’s reimbursement environment is an increasingly challenging and difficult task. Coping with increasing expenses and inadequate governmental funding requires sound financial decision making. Partnering with the right experts can help you make these difficult decisions and improve your financial success.  Wipfli’s health care experts can assist you with all aspects of reimbursement, including:

• Interpreting reimbursement regulations and the opportunities that are available to enhance facility reimbursement
• Providing up-to-date, proactive information on regulatory changes and the impact these changes will have on your operations
• Accurate and timely preparation of Medicare and Medicaid cost reports
• Projecting Medicaid reimbursement rates that incorporate current changes in that reimbursement methodology
• Assistance with audits and the review of proposed audit adjustments

A better understanding of coding processes and billing procedures can help you build a strong foundation for your organization. If coding is not performed correctly, data will be faulty, poor business decisions may result, and overall revenue will not reflect services provided. Not only does problematic coding have a revenue impact, inefficient billing processes increase costs directly (e.g., staffing, resubmissions, high accounts receivable) and indirectly (e.g., frustration levels and morale).

Wipfli assists health care organizations to ensure that their coding is accurate and that revenue and compliance processes are efficient and effective. We are experts in the following areas:

• Analyzing coding and billing procedures
• Identifying discrepancies
• Recommending coding improvements
• Revenue cycle enhancement

Health care organizations require extraordinarily deep and broad expertise and resources to effectively manage the revenue cycles. Governmental rules and regulations vary for each type of service provider, and they are vast. Reimbursement continues to drop, administrative pressures continue to increase, all while resources are shrinking.

There are many people, systems, and activities that all have to work—and work seamlessly—for health care organizations to collect what they are owed in an efficient and timely manner. By looking more broadly at the entire revenue cycle continuum, you can create a better business position for your organization. Our comprehensive services include:

• In-depth discussions with senior management to understand concerns and establish program objectives
• Customized review of operations, including interviews of key management personnel and detailed analysis and documentation of all significant revenue cycle processes, across departments
• Validation of key information with appropriate client personnel
• Creation and implementation of applicable indices and benchmarks (performance indicators)

• Additional $40,000 per year for an opportunity where they were not billing for a procedure code in the ER and should have been
• Additional $105,000 per year for an opportunity for services provided but not set up in the chargemaster (Wipfli typically identifies a minimum of 25 supplies/procedures provided but not set up in the chargemaster.)

One of the most challenging tasks in the business office is tackling insurance denials. If not handled properly, no payment will ever be made on that hospital service.  This two-day, on-site interview and review process will:

• Review the entire collection process from point of service collections to claims adjudication.
• Create a successful denials management team.
• Fix issues at the source of denial.
• Give you proper claims denial management tactics.
• Show you how to manage the process to lower your overall denial rate.