19 Crimes of Mid-Revenue Cycle Leakage

During the Industrial Revolution, Britain’s urban poor skyrocketed as did petty crime.

Throughout 1760-1820, the British court system created lists of crimes punishable by convict transportation to Australian penal colonies to reduce prison congestion (which was soaring) and commute death sentences.

Today, the plethora of Revenue Management vendor solutions has likewise overwhelmed Revenue Integrity professionals leaving them vulnerable to egregious crimes of omission in the fight against margin erosion.

AcuStream, Inc. has now published the following list of “19 Crimes of Mid-Revenue Cycle Leakage” punishable by declining profit margins, underperformance against revenue goals, and misalignment between hospitals and their key physician groups.

  1. Assuming margin compression will resolve itself… the structural changes brought about by the ACA have created a new normal and we have to act accordingly.
  2. Not actively managing a manageable aspect of Revenue Integrity – “Revenue Leakage” – and passively accepting HFMA’s estimate that 3-5% of reimbursable charges don’t get posted when a Six Sigma level of performance would be 10,000-fold improvement!
  3. Chasing revenue unicorns vs. taking a pragmatic approach to revenue optimization. There are very real and immediately addressable problems such as revenue leakage in front of us that we can and should tackle now.
  4. Trivializing revenue leakage or charge capture. Even 0.5 – 1% net income improvement is significant in the wake of an industry whose average profit margin is now <3%.
  5. Inflicting non-productive work on your coding teams in the form of random sample manual charge audits knowing technologic solutions are available that automate audits on 100% of all patient accounts leveraging thousands of rules with better accuracy and consistency.
  6. Blindly believing you have the requisite revenue assurance tools and an accountability culture in place today that specifically guard against leakage. Don’t assume you have either.
  7. Relying on your EMR as a revenue management tool. EMR’s are a system of record; not a tool of choice for managing revenue!
  8. Overemphasizing your CDM as a means for solving leakage. Cosmetic changes to your CDM as though leakage is a book-keeping issue is no substitute for multi-faceted, cross-functional operational PROCESS improvements.
  9. Mistaking Revenue Assurance as a “DIY” (Do it Yourself) opportunity. Outsourcing Revenue Assuranceactivities to an experienced partner with the requisite core competencies, cloud-based technologies and the ability to focus on a singular objective with greater economies of scale is the only cost-justifiable way to treat leakage.
  10. Assuming only pre-bill solutions can effectively solve your leakage woes. The multitude of tools and the resulting frenetic activities of your revenue team to get an initial bill out the door in 3 – 5 days with an industry average 10 – 13% error rate should be supplemented by a post-bill safety net to optimize billing accuracy.
  11. Not aligning HB with PB. You’re pursuing a corporate strategy that hinges on aligning your hospitals and physicians and, yet you still operate your physician billing and hospital billing teams as independent and separate functions.
  12. Allowing your physicians to lose RVUs today and compromise their future reimbursement due to MACRA physician payment adjustments. The size of these payment adjustments will partially depend on the data clinicians submit to CMS. Missing charges and RVUs create data integrity holes in the MIPS Quality Metrics.
  13. Not equipping your Single Business Office (SBO) with a single-vendor solution that covers PB, HB, inpatients and outpatients, and FFS/DRG payer accounts.
  14. Shortsighted thinking that your only lever to combat margin compression is cost reduction vs. revenue optimization.
  15. Looking at outsourced solutions as a cost vs. an opportunity. Worse, looking at revenue leakage defensively as an indictment of the proficiency of your Revenue Team vs. an opportunity to learn, grow and optimize.
  16. Assuming this is a long-term complicated decision-making process. It’s a simple, smart business decision so don’t over analyze it… time is money!
  17. Anticipating IT bandwidth to be a limiting factor that delays the launch of a Revenue Assurance Program. This is NOT an IT project; setting up the data extracts is merely a task in a very brief implementation.
  18. “Kicking the can down the road” by delaying the decision to confront revenue leakage. You can have a Revenue Assurance Program stood up and cash-flowing positive within 90 days with minimal investments of time or money.
  19. Not contacting AcuStream TODAY to start the process.

About AcuStream

AcuStream is a Revenue Assurance specialty company dedicated to the healthcare industry. AcuStream provides automated charge capture auditing technology solutions, value-add professional coding expertise, and decision support tools to the country’s leading healthcare providers enabling our clients to find missed revenue around charges they didn’t know were missing. We are the only organization with proprietary algorithms and custom client specific rules, that can correlate both the hospital data and physician data. This in conjunction with our world class workflow, allows us to find and track missed, miscoded, and misplaced charges.

AcuStream identifies and quantifies missed reimbursable charges for both Physician Organizations and Health Systems. REVBUILDER™’s automated post-bill auditing solution identifies omitted charges while REVREVIEW™ auditors validate charges against your own EMR documentation and payer contracts to ensure you get paid for the services provided.

AcuStream has been privileged to work with one-third of the academic medical centers on the U.S. News and World Report “Honor Roll of Best Hospitals,” seven of the 50 largest integrated health systems, twenty percent of the 20 largest not-for-profit health systems, and 10 of the nation’s largest physician group practices providing immediate financial lift/profitability, management insights and process improvements surrounding Revenue Management.Acustream currently processes over 100,000 doctor’s data on a monthly basis, thanks to our client base of top hospitals and physician organizations in the US. The result of our solution is improved net profit, decreased revenue erosion, and a clear view into departmental efficiencies.

We help you identify the missing pieces to your revenue puzzle, BEFORE you even start to put the puzzle together.