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PSS proprietary technology identifies missed revenue by monitoring and analyzing data at every step of the Revenue Cycle process – from patient presentment to final claim resolution.  Missing charges, incorrectly coded procedures/changes, and unsupported charges are identified and corrected prior to claim submission. Claim error rates are reduced, collection times shortened, while claim denial rates are dramatically reduced. The remaining denials are analyzed in real time and the corrective actions initiated to address the root causes. Payments are tracked and reconciled with the charges.

The same technology can be applied to retroactive charge analysis, to identify the claims with missing charges which may be resubmitted for additional reimbursement.

Is my facility Missing Gross Revenue?

 

Every PSS client knows the answer to this question.  By conducting a simple, non-invasive analysis of the interactions between the Charge Description Masters, Order and Charge Entry Systems, HIM system, Patient Billing System and other related ancillary systems.  Your revenue is recaptured through a 3-step process:

  • Analyze the current situation based on historical data

  • Evaluate the extent of the problem by providing Gross Revenue value to identified missing charges

  • Assign approximate Net Revenue value to these charges based on the contractual terms with each payor.

The Discovery process also detects potential vulnerabilities within the targeted systems and their interfaces with one another, as well as breakdowns in manual processes. 

The results of the data analysis identify improvement opportunities, quantify their potential financial and operational impact and detail manual process improvements in order to achieve sustainable improvements by resolving these issues.

 

Case Study

 

In a typical case PSS analyzed 1 week’s data for a $2 billion gross revenue health system located in the southwestern US. The primary reason for missed charges was weak system integration between various clinical and billing systems. RCIM™ indentified lost gross annual revenue of $20million worth an estimated $9.6 million in collectable annual net revenue.

Further analysis showed that an inordinate number of charged were over 8 days late posting. The RCIM™ Portal was implemented to enable the responsible Clinical personnel the ability to review and initiate corrective actions in real-time.



  • Charge Capture Validation


  • Charge Master Management


  • Denial Analysis


  • Retroactive Charge Analysis

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