Revenue Cycle Management Solutions - Healthcare Sherpa, LLC


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Healthcare Sherpa is a Revenue Cycle Management service provider, which serve end to end RCM services to all Healthcare Providers throughout United States. In Healthcare Sherpa, Revenue Cycle Management Services includes but not limited to
Medical Coding
Insurance Verification
Patient Demographics and Charge Posting
Claim Submission (or) Transmission
Payment Posting
Denial Management
Accounts Receivable Management
Printing and Mailing Patient Statements
We offer all these services as a Healthcare Sherpa’s complete suite or as a standalone services such as only Charge Entry or only Accounts Receivable(etc)… as per our providers (or) clients comfort zone.

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Revenue Cycle Management Solutions - Healthcare Sherpa, LLC

  1. 1. Revenue Cycle Management Solutions 1
  2. 2. Healthcare Sherpa’s Revenue Cycle Improvement System REVENUE CYCLE IMPROVEMENT SYSTEM PLANNING IMPLEMENTATION Identify Benchmark Constant Implement actual/ base Develop process Changes, Set Continually potential performance Management improvement Productivity monitorproblems in to industry Reports to eliminate & Provide performance. RCM cycle standards problem feedback RESULT Increased Practice / Fewer Rejections & Enhanced Cash Flow Fewer Write-off’s Provider Revenue Denials 2
  3. 3. Sherpa’s Auto-regulating Process Flow to Increases Revenue, Enhances Cash Flow and Reduces Write-Off’s Proper input of patient insurance info & codes into the billing software Cycle billing method for Verify address / patient statement and three statements scenario insurance change at for collections every encounter Involve patients in the process for faster Insurance Eligibility payment & Verification 24 hrs TAT by Timely follow-up & No resubmissions without submitting claims carrier calls on same day Delay in submitting claims at the year beginning (to reduce no. of deductibles 3
  4. 4. Scheduling and Patient Registration 99% accuracy with process for gathering Problems complete patient demographic information reduces 20% of rework • Inaccurate / Incomplete patient Demographic Information Sherpa’s Process-oriented Insurance and Eligibility verification leads to faster payment within • Inaccurate / Incomplete Insurance information Solution 20 days• No verification of financial information Process based verification of patient ‘s plan benefit, results in prompt 80% POS collections 4
  5. 5. Charge Posting 20% additional effort in charge entry with random Q.C. reduces duplicate charges & time spent chasing wrong AR by 5% Problems Process based posting and submission of all services bring down TFL exceed denials • Duplicate Charges by 99% and reduce revenue loss by 2-5% • Un-posted Charges • Wrong Insurance Sherpa’s Process based insurance verification keeps claim resubmissions ratio to Selection Solution 2% • Missing Authorizations & Referrals Good knowledge of insurance id formats and an extra minute spent to recheck• Neglecting Payer insurance keeps claim rejections below 2% Contracts Separate process step reduces authorization and referral denials to 5% Process step for generating charge reports and regular contract updates ensures correct contract details and keeps contract denials under 1% 5
  6. 6. Payment Posting Facilitate EDI agreements with insurance companies. Leverage electronic posting to Problems track payments and to bring down AR Balance to 15% • Lack of reconciliation • Patient statements Sherpa’s Ensure accurate analysis of EOB and bill with wrong patient correct patient balance to avoid compliance balances Solution issue• Ignoring secondarypayment submission Sherpa’s process for secondary re-submission by printing or uploading the primary EOB’s brings loss of revenue down from 10% to 2% 6
  7. 7. Denial Management Problems Denial analysis and prompt appealing • Medical necessity • Non-Covered Services Sherpa’s Process-oriented COB verification • Co-ordination of benefits Solution• Prior-Authorization / Referral Ensure claims submission to insurance with auth/referral & Retro-auth appealing 7
  8. 8. Insurance Follow-up Improved workflow process and increased productivity using our Problems proprietary AR tracking spreadsheet to prevent 30% loss in revenue. • Lack of proper follow-up • Pending claims never Prioritize work on Old AR and try worked to collect >7% of old claims • Erroneous claims that Sherpa’s are not resubmitted Solution Improved claims appeal process prevents • Ignoring Old AR up to 20% loss in revenue • Ignoring claims appeal Process-oriented insurance• Ignoring insurance correspondence with necessary actions (e.g., Medical Records, Primary correspondence EOB etc.,) eliminates payment delay 8
  9. 9. Self-pay Follow-up Getting correct patient address from USPS & verifying with TP software Problems (e.g., White pages) to avoid sending statement to incorrect address • Incorrect data collection at front desk • Statement sent to wrong address Sherpa’s Proper insurance eligibility verification along with benefit plan to eliminate non-covered • Rendering Solution service denials Non-Covered services• Inadequate patient contact Leveraging experienced patient account representatives to lower Bad debt adjustments from 20% down to under 5% 9
  10. 10. Privacy Confidentiality & HIPAA Compliance• Secured Premises- guarded 24*7• All employees signed to a confidentiality agreement• Restricted and monitored internet access• No media drives• HIPAA compliant Secured Data transmission• HIPAA compliant products and procedures• Frequent training and trouble-shooting per HIPAA guidelines 10
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