Revenue Cycle

The Wilshire Group evaluates, improves and manages all steps of the revenue cycle from patient arrival through account completion, creating simplified, integrated revenue cycle workflows for our customers. Our proven work methods, tested process improvement methods, and knowledge of industry-leading technology will allow you to achieve predictable and measurable results that exceed your current cash position.

Today, hospitals are challenged by ever-increasing operating costs, uncollected revenues and issues retaining staff in key Revenue Cycle departments. These issues are prevalent due to inefficiencies in revenue cycle processes and misalignment of technology, process workflow design and personnel in the total solution. Revenue Cycle Management performance can be significantly enhanced through objective assessment, innovative improvement planning and implementation of effective information management systems.

The Wilshire Group takes a comprehensive approach that evaluates, improves, and manages all components in obtaining patient encounter information and applying it to ensure patient safety, while creating simplified, integrated workflows designed to optimize and expedited reimbursement.

 

Our Support Specializes In:

Operational Assessments


We perform operational assessments for your healthcare organizations revenue cycle program that aassess compliance, efficiency and financial viability. Our assessments include:



  • Evaluation of existing systems, documentation, staffing and operations.

  • Evaluation of financial performance including assessment of coding, billing and collection systems.

  • Evaluation of provider records, documentation and compliance with various local, State and Federal regulatory requirements including the Health Insurance Portability and Accountability Act (HIPAA), The Joint Commission and state licensure.

Interim Operational Management


When a hospital or health system is in utter chaos, it is often necessary to retain a seasoned interim healthcare management director to lead the organization back into calm waters. We have a team of experienced revenue cycle directors who have the maturity and experience to provide this form of extraordinary leadership. The Wilshire Group offers a wide range of expertise to help your organization navigate any operational or strategic challenge requiring prompt resolution. Moreover, every interim manager in The Wilshire Group works closely with you to ensure that you receive exactly the hospital management services you requested.

Collection Support


The prompt and appropriate reimbursement of outstanding claims is the biggest challenge facing many of today's healthcare organizations. With your uninterrupted revenue stream as our chief objective, The Wilshire Group's proven track record for expediting the recovery of both self-pay and insurance reimbursement is impressive. However, it's the polite, respectful way in which we administer our collections efforts that makes The Wilshire Group such an attractive outsourcing option.

Workflow Redesign


Inefficient processes and associated workflows waste time and money. The Wilshire Group will work with you utilizing our years of expirience and expertise to analyze and design processes which will result in a dramatic improvement in throughput, accuracy and staff satisfaction. We will analyze current revenue cycle workflows in your business processes, and recommend changes to improve operational performance and patient satisfaction.

Denials Management


A chief concern of healthcare organizations today is decreased claims reimbursement due to claim denials. To combat this concern denials management has become common practice in many healthcare groups, but the challenge of how to accurately and quickly identify the sources of the denials through comprehensive analysis still remains. The Wilshire Group can work with you to analyze and track your denials management operations. We want to help you combat denials and improve your organizations cash flow as quickly as possible.

Hospital Coding Workflow Review


The Wilshire Group offers coding process assessments to evaluate the impact HIM operations has on the revenue cycle process, recurring or short-term coding and documentation audits, as well as education to coders, physicians, and the clinical documentation team. We work closely with you to review troublesome workflows, and will provide with recommendations for improvement based on our years of coding and HIM expirience.

AR Reduction


The Wilshire Group specializes in reducing and recovering your accounts receivable. Based on our expertise, we offer the solution to reduce your AR by improving cash flow, recuding outstanding claims and rejection, and working with you to expedite payments for services. Whether challenges relate to third-party payer contract administration, claims processing, information systems, or operational issues, Wilshire works with you to identify areas to improve. Our proven work methods, tested process improvement methods, and knowledge of industry-leading technology will allow you to achieve predictable and measurable results that exceed your current cash position.

Contract Analysis and Negotiations


The Wilshire Group provides modeling and detailed analysis for hospitals to accurately forecast revenue and profitability of proposed payor contracts. Hospitals can model the impact of proposed reimbursement terms using their historical data to ensure accurate estimates of utilization and charge patterns and compare the projected effective discount rates for true side-by-side comparison between various contract terms including Medicare. For hospitals with limited resources to model prospective contractual agreements, Wilshire offers a Payor Negotiation Support Service. This value-added support ranges from contract modeling, to data analysis, to face-to-face payor negotiation. Our service also allows clients the ability to access experienced contract modeling / negotiating staff who can provide accurate analysis in an efficient fashion during the negotiation process. Also TW's experienced staff can serve as the "front-line" person carrying out the negotiations and/or providing "background" assistance to hospital negotiators. The Wilshire Group's knowledge of managed care markets can create substantial improvements in rates, terms, and other conditions to achieve a balanced win/win contract.

Silent PPO Review


It is estimated that errors occur on 3 to 8% of all payments from HMOs, PPOs, and other third-part payors. These organizations routinely take unintended discounts, known as 'Silent' PPO discounting. The Wilshire Groups's expirienced professionals will work directly with you to achieve the goal of having every claim paid correctly by conducting a comprehensive review of your Silent PPOs. With more than a decade of experience of working with clients, we have the expertise to help you recover revenue and save even more by preventing future unauthorized discounts.

Worker's Compensation Review


Workers compensation policies, while simple in thier concept, have many areas where simple errors can cost healthcare organizations thousands of dollars. The Wilshire Group has the professionals available to conduct a workers compensation policy review for you to help ensure those simple errors are avoided and/or corrected. Our goal when conducting these reviews is simple; find any errors that would adversely effect your organizations policy. Once those errors are found, our consultants will work with you to have these errors corrected as quickly as possible.

Litigation Support


The WIlshire Group specializes in litigation issues reagarding all aspects of the revenue cycle in healthcare organizations. Our professionals have all personally held key director level positions in the healthcare industry, and have dealt with litigation issues for years. We are industry knowledgeable in all areas, from contract negotiations and operations to risk analysis and claims evaluation. With our expirience, we are able to assist with litigation support by reviewing medical records, analyzing and evaluating medical and administrative events, and addressing standard of care.

Managed Care Payment Review


The Wilshire Group provides complete assessments and thorough review of your managed care contracts. We strongly believe that these assessments will allow for better and more timely negotiations. We understand the terms and conditions in your current agreements can cost you money or prevent you from yielding the anticipated revenue. Our goal is to remedy that by providing you with a review of your current position, as well as the actions needed to improve.

Chargemaster/Charge


Capture Hospitals face rejected claims, delayed reimbursement and lost revenue when they fail to keep their chargemaster current and accurate. However, maintaining and updating the chargemaster can be an extremely time-consuming task associated with high costs. To achieve appropriate payment in compliance with the laws and regulations of the Centers for Medicare and Medicaid Services (CMS), hospitals must code and charge the correct procedure(s), the full extent of the procedure(s), and all procedures performed. However, with constant changes to codes and continual amendments of government rules and regulations, chargemasters are often incomplete, inaccurate, and mismatched to revenue codes. The Wilshire Group offers a comprehensive review of your chargemaster to identify areas of missed opportunities, coding and billing compliance, and operational best practices. As part of our work with you, we will also provide education and staff training. Whether you are moving your chargemaster to a new system, or are simply working on optimization efforts, Wilshire has the tools to assist you along the way.