Personalized hospital revenue cycle solutions.
✓ Utilization review
✓ appeal strategies
✓ Front, mid, and END cycle alignment
✓ denial mitigation
Hospital revenue cycle solutions
How do we partner with your organization?
We partner with you to determine CMS regulation compliance, opportunities to reduce denials, and develop an appeals strategy that works for your healthcare system.
What areas of revenue cycle do we specialize in?
We specialize in Prior-Authorization, Utilization Review, Physician Advisor Services, Appeals, and Denials. As clinicians and subject matter experts who have worked in healthcare, we have unique perspectives and experience that can serve your company.
Are UR and Appeals that important?
A robust UR and Appeals team, including physician advisors, can help you maximize compliant revenue. We want to ensure you don’t leave money on the table.
What kind of revenue cycle solutions do you offer?
We conduct an assessment of your current processes and teams and provide an analysis of opportunities. We’ll work with your access/registration, pre-authorization, and insurance verification teams to determine process alignment opportunities. We offer three service tiers: assessment, assessment and plan, and assessment, plan, and implementation.
How long is the process?
Our assessment is personalized and the timeline for completion depends on the size of your organization. Contact us to schedule a consultation and receive a personalized quote.
Hospital Revenue Cycle Challenges
Healthcare has endured monumental challenges in the past five years. After the pandemic, hospitals saw their thinnest margins and unprecedented financial losses. Kauffman Hall reported hospital operating margins were 0.3% in 2022 and 1.2% in 2023. Crowe RCA reported 2022 as the highest year for take-backs since they started tracking that data. In 2023, Inpatient audits grew by 32% compared to previous year.
The last few years have taught us that protecting revenue and reducing leakage is critical to maintaining financial health. Our hospital revenue cycle solutions help you protect the financial health of your organization.
Healthcare in 2023
- 170% increase in hierarchical conditions coding audits
- 300% increase in DRG audits
- 54% increase in specialty drug audits
- Medicare Advantage plans crossed threshold to represent 51% of all Medicare beneficiaries
Medicare Advantage Plans
In January of 2024, CMS-4201-F went into effect. This ruling provided clarification on CMS’s expectation that Medicare Advantage (MA) plans follow the 2 Midnight rule. Most healthcare systems have reported limited, if any, change in payor behavior related to this CMS ruling.
A Focus on Prior Authorizations
CMS-4201-F also clarified that MA plans must adhere to the LCD and NCD criteria, extended the validity of prior authorizations, and required MA plans to utilize physician advisors with relevant experience to the cases they were reviewing and denying.
It’s Not Getting Easier.
The landscape of reimbursement is not getting easier or simpler. Our subject matter experts can help you design and implement processes that maximize your revenue. Let us help build solutions to the challenges healthcare faces today.
Hospital Revenue Cycle Solutions
Service Tiers
Assessment
A comprehensive assessment of your UR, Appeals, Prio-Auth and Physician Advisor processes and teams.
✓
Personalized assessment
✓
Gap analysis
✓
Ranked areas of opportunity
Assessment and Plan
A comprehensive assessment and roadmap to success with suggested strategic interventions.
✓
Personalized assessment
✓
Gap analysis
✓
Ranked areas of opportunity with associated action plans
✓
Change management solutions and interventions
Assessment, Plan, and Implementation
Intervention and implementation support for 12 months.
✓
Assessment and plan
✓
Dedicated coaching sessions
✓
Onsite change management support
✓
Ongoing education need assessment
Our Amazing Team
Dr. Tabitha Hapeman
Founder, Principal
Leader, PMHNP, passionate change agent.
Dr. James Mooney
Principal
Physician advisor, clinical risk adjuster, CDI expert.
Shelly Wood
Principal
Prior-authorization, denials, and process design expert.
Lisa Henderson
Principal
Clinical appeals, quality, process improvement, and denials mitigation expert.
