Revenue Opportunity Roadmap Revenue cycle management starts out simple enough: Collect enough money from the payers for the services patients receive to cover costs, and still create enough profit to compensate the providers. But it doesn’t answer the question: How do we increase profit? We think there is a different way to approach this challenge: create a customized plan for increasing profit, using proven modeling to identify the most critical and most overlooked opportunities in your revenue cycle.


Where Did All the Money Go?

“We’re working just as hard, but receipts are down.” Does this sound familiar?

Revenue Cycle Management can be a daunting task: perfecting the delicate formula of what payers are willing to pay, covering the expenses of the clinic and still have income available for distribution to the providers. Many practices are faced with lower payments, increasing expenses, and stricter compliance issues – which mean even more pressure on profits that are available for distribution to shareholders. With payer’s decreasing their reimbursements each year, are there even any expenses left to cut?


Revenue Opportunity Roadmap

We think there is a different way to approach this challenge: create a customized plan for increasing profit, by using proven modeling to identify the most critical and most overlooked opportunities in your revenue cycle. What we call, a Revenue Opportunity Roadmap.

MOST CRITICAL
Procedure Pricing
Ailment
Are procedures being priced correctly?
Symptoms
Without a competitive fee schedule, how would we know if there is missed opportunity? Comparative data to help you solve this problem is difficult to find.
Solution
Work with healthcare industry experts who have access to the data you are missing, and also have experience navigating complex Sherman Anti-trust rules, laws and regulations.
Outcome
A clear pricing strategy for beating the competition. Increased profits, with less compliance risk.
Accurate Coding
Ailment
Why is there a coding and collection mismatch?
Symptoms
Providers are rarely available when coders have questions. This can hold up the billing process, or lead to “down coding.”
Solution
Assign specific coders to a specific provider. Educate coders and providers on a regular basis. Hold coder meetings to discuss similar issues.
Outcome
Provider/coder communication and relationships will improve. This leads to correct billing and coding for services provided.
Staff Performance
Ailment
Why are we experiencing staff turnover?
Symptoms
Improper job/skill set definitions leads to unqualified professionals and personality mismatches. Lost revenue and poor employee job satisfaction.
Solution
Identify leading approaches on policies and procedures for similar specialties. Create a well-defined chain of command and job descriptions that match individual’s qualifications.
Outcome
Lower overhead and higher profits will result. Employee’s expectations will be better defined. Better employee engagement, higher job satisfaction, and lower turnover.
Unrealized Billings
Ailment
What revenue are we missing out on?
Symptoms
Administration feels challenged when someone questions their authority. Coders feel challenged when someone questions their skills. It’s a painful process, so it’s avoided.
Solution
Identify procedures where real opportunities exist, then establish a competitive fee schedule, which also helps with contract negotiations.
Outcome
The time and stress involved to develop a billing strategy is reduced. You know (and can show) your practice is not leaving money on the table.
Quality of Referrals
Ailment
Do we really know where our patients are coming from?
Symptoms
Business is declining and your practice has no clear way of tracking referrals to get at the cause. Or, the type of referrals are changing and not a match for your ideal patient.
Solution
Identify who sends patients to your clinic. Develop a plan to track quantity, quality and trends.Get the facts behind the assumption.
Outcome
A clear picture will lead to better relationships with each referral source, and better quality of the referred patients for your specialty.
MOST OVERLOOKED
Denied Claims
Ailment
Why are our denials above the norm?
Symptoms
Your internal outstanding receivables report shows claims never paid, and payers “down coding” care. Every payer plays by their own set of rules.
Solution
Look for patterns of denied claims. Have specific coders work on specific payers and identify a go-to contact person at every payer’s office.
Outcome
Income increases while overhead simultaneously decreases. Employees are more productive and happier with fewer frustration of denied claims.
Market Positioning
Ailment
Are we billing more, or less, than the competition?
Symptoms
Creating reports is time consuming without prior knowledge. Even then, do you know where to get the industry data to compare?
Solution
Tap into the right resources – industry benchmarks and analysis are available if you know where to look. Working with outside experts can build your reports, quickly.
Outcome
Your clinic is more competitive in the marketplace – which can support goals like attracting new patients and increasing referrals.

Your Path to Better Profit Begins Here

The first step to thrive (not just survive) the changes taking place in healthcare is to understand your revenue cycle and uncover all possible areas that can be improved. Revenue cycle management (RCM) isn’t a singular event. It involves the relationship between the patients, providers, employees, payers and an overall understanding of the business process.

DS+B healthcare specialists have the experience and expertise to help you develop a roadmap that takes the guesswork out, and puts in place a clear path toward improved profits for your practice, and providers.

Let’s start a conversation, today. Contact us.