The Blind Spot of the Healthcare Revenue Cycle
While most organizations have invested heavily into managing all aspects of their healthcare revenue cycle, very few have adequately addressed the “blind spot” that exist in the revenue cycle. This blind spot refers to the convergence of clinical decisions, evolving regulations, inconsistent contractual obligations, billing rules, and reimbursement management. The performance of the hospital’s utilization management (UM) department plays an integral role in managing these challenges.
UM has not been equipped with advanced tools to improve visibility and impact on the revenue cycle. Hospitals have not invested to maximize efficiency. They have spent in Case Management and Internal Physician Advisors but not provided them with the right tools to ensure optimal performance.
Analytics to Identify Opportunities
Versalus Health has developed a portfolio of advanced analytics designed to “close the loop” between UM, billing, reimbursement, managed care and compliance. Versalus’ analytics utilize hospital encounter, billing, reimbursement and utilization management data and compare it against national benchmarks, hospital, payer-specific contract terms, and billing rules in order to detect compliance risk, identify revenue integrity opportunities, discover processes or technology flaws, pinpoint areas for additional education and tailor process improvement based on findings.
Services to Improve Performance
Versalus Health supports hospitals and health systems with specialized expertise including Physician Advisors; regulatory experts; case management, clinical documentation, coding, finance, billing, and revenue cycle professionals. Our services are tailored to each client and are designed to leverage internal capabilities, resources, and talents. Versalus helps clients identify issues and opportunities quickly, take the actions needed to improve performance, and continuously monitor to ensure sustained results.
How We Help Clients:
Utilization Management, Billing, and Regulatory Compliance Process Redesign
Physician Advisory Services
Including Concurrent and Retrospective Case Reviews
Medical Director Audit Reviews and Support
Physician and Utilization Management Education
Medicare and Private Payer Appeals
Private Payer Contracting and Negotiation Support
Hospital Payment Litigation Support
CMS, OIG, DOJ support
The Versalus solution leverages a data-driven, outcomes-focused approach to optimize our client’s case management and physician advisor teams. For organizations that have established a Physician Advisor team, we offer solutions that complement their teams. We provide them with the information they need to effectively do their job. However, for those that have not developed internal capabilities, we offer a program that includes all physician case reviews, audits, appeals or specific expertise to complement existing programs.
The result is a process that provides unprecedented visibility, ensures efficient use of resources and in-house capabilities, increases revenue, improves compliance, and maximizes returns on managed care investments.
- Align Medicare compliance metrics with national benchmarks
- Ensure that your process is delivering compliant outcomes
- Receive all the appropriate revenue that you are owed for Medicare and Private Payers populations by quantifying and understanding sources of revenue loss
- Reduce manual screening reviews by up to 80%
- Focus valuable Case Management and Physician Advisor resources on the most important activities
I implemented Versalus at my last organization with tremendous success. When I accepted the position as CFO for a 6-hospital system, one of my first calls was to Versalus. We are now implementing the Versalus solution for both traditional and managed Medicare. I’ve been a finance executive for 25 years and can really appreciate the true partnership that we’ve had with Versalus. We worked together to craft solutions that leveraged our internal expertise with their analytics. The results have been very tangible: improved revenue, enhanced compliance, and much better performance visibility.”
Upcoming Webinars and Events
Versalus Health Blog
- Chasing KPI’s: How Department Metrics Undermine Hospitals' Medicare Advantage PerformanceTo evaluate Managed Care contract performance, hospitals should establish a global KPI and focus their efforts on five metrics driving hospital revenue erosion. By Joseph Zebrowitz, MD Read more »
- Medicare Advantage: The New RAC’sMedicare Advantage: The New RAC’s The Recovery Audit Contractors (RACs) have branched into other areas of audit in hospitals - Medicare Advantage (MA). Since MA plans employ multiple vendors, the scrutiny of hospital claims is almost never-ending. So, who are these RAC-like vendors being used by MA plans? And what… Read more »
- Not Hitting Your Revenue Cycle Benchmarks? Look at Utilization ManagementIt is a truism that hospital financial outcomes result from an interdependent web of departments contributing specific functions and deliverables, commonly referred to as the revenue cycle. Each silo – admitting, managed care contracting, utilization management, billing, and collections operates largely within their own area of expertise. Each department delivering… Read more »
- The Role of the Physician Advisor in the Observation Rate ConversationThe Role of the Physician Advisor in the Observation Rate Conversation Read more »
- Aligning Payor-Provider UR Practices – Proceed with Caution!Aligning Payor-Provider UR Practices – Proceed with Caution! Read more »
- You Can’t Get the Right Answer if You Don’t Ask the Right QuestionIn 2013, the Centers for Medicare and Medicaid Services (CMS) finalized the “Two-Midnight” Rule addressing when beneficiary hospitalizations are appropriate for inpatient payment under Medicare Part A. Read more »
- Vulnerabilities Remain Under Medicare’s 2-Midnight PolicyIn 2016, the Office of the Inspector General (OIG) published a report, “Vulnerabilities Remain Under Medicare’s 2-Midnight Policy”, summarizing the first findings of hospital billing patterns since the implementation of the Two-Midnight Rule. Read more »
Assess Your Risk and Opportunities
Do You Know How Your Program is Performing Relative to Established Benchmarks for Compliance and Revenue Integrity?
Our team can perform a Compliance Baseline Assessment to evaluate how your program is running.