Revenue Cycle Solutions

Drive strong revenue cycle performance through integrating clinical and financial workflows, coordinating Revenue Integrity strategies, optimizing technology and monitoring payer behavior with next generation analytics.

Today’s revenue cycle environment represents the sum of all its parts.  Clinical and financial workflows and their enabling technology must work in concert with one another to effectively generate the expected net revenue.  Many actions and decisions must happen at the right place and at the right time to enable proper claim generation.  Even well-performing healthcare organizations are faced with the continual task of monitoring their internal processes as well as external payer behavior to ensure they receive proper reimbursement.

Complexities within the revenue cycle have increased exponentially and the trend is expected to continue with the following factors in play:

Current Challenges:

  • Healthcare providers are unfamiliar with managing risk
  • Limited population increase local financial risk to the healthcare organization
  • Siloed processes reduce efficiencies and increase cost
  • Technology is not properly built and utilized
  • Lost revenue capture through breakdowns in clinical and financial workflows

Industry Trends:

  • Increased risk shifting from payers to providers
  • Implementing next generation IT integration across the healthcare continuum
  • Growing payer complexities including quality incentives
  • Increased consumerism

Through improved workflow and technology utilization, our team helps your organization improve your ability to improve net revenue performance of your organization.

How We Help Our Clients

  • Optimize technology
  • Streamline workflows to improve data integrity and efficiency
  • Ensure charging and billing processes align with Payer Agreements to drive appropriate reimbursements
  • Determine payer behavior to trigger denial avoidance procedures and underpayment recovery
  • Improve billing workflows to reduce delays in cash collections
  • Reduce accounts receivable
  • Improve cash as a percentage of net revenue
  • Educate and improve revenue cycle performance oversight

QHR's IT consultants help clients maximize the value of their IT investment. We develop the business case for needed improvements and help you determine the specific system needs critical to attaining your goals. We can also help you streamline processes and workflows to maximize efficiency and configure systems to address patient safety and security concerns. In addition, our IT team can help hospitals with:

Featured Capabilities

• Financial risk mitigation – EHR Implementations & IT System Optimization
• Payer Yield Improvement through integrated Managed Care and Revenue Cycle efforts
• Revenue Integrity Improvement
• Streamlining processes and workflows across the Revenue Cycle and clinical departments
• Development of an Integrated Revenue Cycle Steering Committee

QHR EXPERTS

Principal, Revenue Cycle
Director, Managed Care Services
Senior Revenue Cycle Consultant

INSIGHTS

White Paper

Population Health: Moving Beyond Treating Illness to Improving the Health of a Community

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