surgical revenue cycle — impact points

Solution Process Diagram

Surgery Planning: Automates the manual steps associated with scheduling a surgery. Equipment requests, surgery details and information required for preauthorization are efficiently and easily compiled. A comprehensive surgical document is compiled and routed to all appropriate staff and locations. Provides coding alerts based on CCI edits, coding rules and contract terms. Frequently performed surgeries can be saved and stored as memorized surgeries. Once a surgery is planned, coding takes only seconds!

Insurance Authorization: Implement online work tools that identify scheduled surgeries for which an insurance authorization is needed, but has not been obtained. By proactively identifying and working these cases prior to performing a surgery, denials are minimized and cash flow improved.

Procedure Coding: CrossCurrent improves your coding process by ensuring the optimal combination of codes and modifiers are identified based upon the actual procedure, and then prioritizes all transactions on the basis of risk and value, and preemptively eliminating reasons for claim rejections. Provides bundling and coding error alerts based on rule sets and payer contracts. Modifiers are automatically applied. Properly implemented, the software and consulting services delivers structural process changes to a clinic that result in measurable, sustainable revenue increases while simultaneously lowering compliance risk, claims rejections and unpaid services.

Billing & Collections: Implement a set of exception-based, workload management tools and strategies that complement your practice management system. Focus on preventing untimely billing and improving third party payer performance. Train clinic business office personnel in the use and prioritization of these tools.

Remittance Auditing / Payment Reconciliation: CrossCurrent calculates the expected payment amounts for each case based on the payer's contract terms. As remittances arrive, underpayments are easily identified by comparing contractually based expected payment projections to what was actually paid. In generating these complex reimbursement projections, incorporates even the most complicated contract methods and terms such as “carve outs" (unique payment arrangements), RVU's (relative value units), GPCI (geographic practice cost index) codes, use of multiple modifiers, and price reductions for multiple procedures performed.

Denial analysis is performed and remediation is implemented to prevent future denials.

Dispute Resolution: When the allowed and expected amounts do not match, INCISIVE™ will automatically generate comprehensive dispute documentation addressing the accuracy of the payment based on the specific terms of the payer contract for every procedure performed. Complex coding rules are aligned to the clinical data, enabling surgeons to present a more compelling and detailed case for complete reimbursement. By automating these processes, the time required of both surgeons and their staffs to dispute underpayments is dramatically reduced. Over-payments are also identified, protecting surgeons from allegations of fraud.