Hospitalist Billing Services

• Over a 98% first pass acceptance (average is 70-90%)
• Real time claim tracking and adjudication
• AI-enhanced automations and quality control measures
• 100% revenue cycle transparency at the micro and macro levels
• Claims go out in an average of 10.2 minutes
• New RCM specialist and billing hires are required to have a starting accuracy of 98% and don’t go live until they achieve 99%
• 4500+ certified coders, billers, and RCM specialists on staff
• Automated quality control checks and feedback loops for business intelligence and revenue growth opportunity analysis
• 100% transparency, visibility, and data availability in real time
• Full service coding automation with an average ROI of 7.1-14.3%
• Coding efficiency measures and checks to protect against revenue loss from under coding and audit risks from over coding or inefficiencies
• Provider benchmarking on a state, national, and specialty level for peer to peer analysis, provider productivity evaluations, and risk assessment.

• Eliminate AR gaps and stuck points with revenue cycle perfected.
• Machine learning provides data analyses for physician improvements
• AI-Enhanced robust rules engine with hundreds of in-process tracking and evaluation options fully customizable to your practice and providers
• KPI provider and practice analytics with predictive data intelligence
• 99.9% uptime with multi layer recovery solutions and data protections
• Real time claim tracking with multi stage evaluations for increasing accurate data including collection value estimates and timelines
• Real time provider and practice revenue updates as claims process for reporting as well as compensation management formulas.
• Denial and underpayment management
• Credentialing and contracting services with high historical ROI returns
• Claim review and scrubbing as well as appeals at all levels
• 100% of appeals are processed within 5 business days and 96% are processed within 1 business day.
• Real time comprehensive provider and practice reporting across standard and custom requirements to ensure your team has 100% data visibility

Benchmarking the revenue cycle management metrics of a clearinghouse is a very effective tool for evaluating the quality of the RCM service yet a clear understanding of the terms combined with qualifications of success criteria are essential for comparing one RCM company against another and making the best choice.

Clean Claim Rate Can Be Misleading

The term clean claim rate refers to a clearinghouse’s degree of consistent success in getting claims processed but nearly every clearinghouse worth it’s weight has a rate that exceeds 90% and the metric has been relatively outdated by increasingly complex payer rules.

The bottom line is that using clean claim rate as a reliable RCM benchmark for evaluating a revenue cycle service company is a flawed approach primarily because of its marginal impact on cash flow.

First Pass Claim Yield is a Top Metric

This represents the percentage of claims that are paid on their first submission, putting the emphasis on denial prevention by requiring a higher allocation of time and resources to the pre-claim submission process, limiting the number of incorrect claims which is turn reduces time spent working on denials while increasing cash flow.

The bottom line is that focusing on first pass yield creates more work on the front end yet driving measurably higher RCM efficiency.

KPI Evaluation: Net Collection Ratio

The net collection rate is the adjusted rate that measures the effectiveness in collecting reimbursement payouts.

The bottom line is that like first pass yield, the net collection rate is an indicator of the relative success or failure of the revenue cycle service by evaluating what percentage of everything owed is being collected.

True Reimbursement Rate

True reimbursement provides the most accurate assessment of bottom line revenue by analyzing 48 in-process KPI metrics, including all those listed above. By rating them individually then combining to create an aggregate out of the total possible, the percentage score representing the degree of maximized reimbursement that can be compared against other services or in-house billing teams. The industry average is 94.5%. Good is 97%. Great is 98.5% The top percentile are 99.5% or above.

Evaluating Your A/R Realization Rate

A high quality accounts receivable process is critical to a providers success and possibly the most critical KPI for evaluating the success of an RCM company. The magnitude of accounts definitely matters but the age of those accounts creates some of the most important RCM metrics for evaluative purposes.

The bottom line is that evaluating the percentages at more than 30, 60, 90, and 120 days gives crucial insight into where in the AR process the majority of claims are being paid and what degree of success is occurring at each stage for the more difficult .

We don’t just offer general RCM services for hospitalists, physiatrists, and physicians on the move, we designed everything we do for doctors on the go from specialized software to exclusive billing with a team that specialized in hospitalist revenue cycles.

• Proven experience partnering with complex health systems including integrations with 30+ practice management and EHR systems
• In that span we are responsible for $1.5B+ in Revenue Improvement and handle 5M+ insurance calls per year
• Over $200M+ in Cost Reductions have been delivered and 20M+ charts coded
• We currently have active prospering clients in 49 states across 60+ specialties and just hit the anniversary of our first 20 year client
• We provide RCM services for over 1700 practices and process 1.5B payments per year and have over a 99% retention rate over five years