With every hospital-based program client, we have been able to improve the revenue side of the business. Our reimbursement specialist has over 30 years of dialysis and nephrology-billing expertise. HDS can assist you through an overview of your billing process and help you identify and maximize expected net revenues, while insuring that your claims contain the necessary support documentation. We provide an audit of a sample of claims in order to identify inefficiencies and assist in defining processes that will ensure accurate and timely claims processing. We also have extensive experience in training and mentoring hospital billing personnel.
Services below can be mixed and matched:
Revenue Identification
One of the most common challenges seen in HDS’ hospital-based consulting activities is that hospitals don’t have a good understanding of the REAL net revenues generated from their outpatient dialysis operations. Only when expected net revenues are finally identified and understood can an accurate contribution margin analysis be completed. Once there is a clear picture of true contribution margin, short and long term planning can occur. “Expected net revenues” or ENR is calculated from the “bottom up”, on each month’s treatment and ancillary pharmacy utilization. Payor mix and payment rates by payor are included in this calculation. The result is ENR per treatment for a given time period which can then be compared to the costs necessary to provide the SAME TREATMENTS. In addition, the ENR provides a benchmark from which to measure actual “dollars collected”. In other words, are you collecting every dollar that you should be?
HDS brings an expected net revenue calculation tool that is based upon years of research and development to accomplish the goal of calculating an accurate ENR on an ongoing basis. These ENR data are then trended and summarized by quarter, semi-annually, and annually.
Billing Audits
Since the Prospective Payment System was implemented in 2011, there has been growing list of questions regarding how to optimize dialysis reimbursement and a need for a deeper understanding of how the various reimbursement adjusters work. HDS audits a representative sample of claims from a recent month. We gather all of the information including physician orders, patient record, compilation forms, charge entry forms, claim forms, and explanation of benefits forms to ascertain how to improve this flow of information and optimize reimbursement. We also investigate the new patient registration system to insure that the proper information is gathered in a timely manner.
Training a “Biller” or a “Dialysis Revenue Champion”
HDS can not only train your biller to carry out the billing function, but also create a REVENUE CHAMPION. The revenue stream is the lifeline of your business, and if AR gets out of control, life can get difficult in today’s operating environment.
HDS can provide ongoing support to your revenue champion in the form of updates to charge master and the latest changes in reimbursement rules and requirements.
