Three Signs a Hospital Needs a Revenue Cycle Enhancement Consultant

Hospitals today are challenged to receive full reimbursement for their services as they navigate multiple complicating factors such as value-based care, increased denials, staff shortages, COVID-19 response, and ongoing changes to coding guidelines. The Paramount Health Solutions team sees three key signs when a hospital should seriously consider partnering with an outside revenue cycle enhancement consultant. These include:

  1. A large volume of denials from payers. When a hospital’s bills are denied based on coding issues, that’s a sign that an internal process – whether from incorrect coding or purely from provider documentation – is a cause of the denials. The result is significant levels of reimbursement being missed.
  2. Difficulty recruiting and retaining experienced, qualified staff to work onsite for CDI/DRGV. Depending on geography and the competitive environment, hospitals can struggle to find the right people to work onsite in the critically important areas of CDI, DRGV and coding.
  3. When CMI drops. A downward trend in CMI, or Case Mix Index, indicates financial stress and can be an early warning sign of impending bankruptcy.

One of these factors is bad enough, but when you see all three of these indicators, it’s a bright red flag. Rather than suffering through financial distress or even entering into bankruptcy, call the Paramount Health Solutions team to perform a 90-day pre-bill audit to find revenue opportunities to help with immediate cash flow. There’s no out-of-pocket cost for this service. If you like our services, we can discuss an ongoing pre-bill agreement so we can help your organization get back on track for ongoing success. Our CDI/DRGV team has more than 50 years of experience, both as hospital-based physicians and outside advisors. We strive to establish a strong and trusting relationship with our clients, helping to implement strategic modifications that improve revenue streams and save money. Our average dollar find is between $2,500 to $4,500 per chart, often yielding more than $100 million in additional revenue to clients. To get started, connect with us here, or give us a call at (615) 347-4867 or (210) 725-3444.