Hospital & Professional Billing

Managing your hospital and professional revenue cycle is not an easy task. Whether it be charging, billing edits, claims submission, insurance follow-up, or self-pay collections, we’ve got you covered.

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Signs You Need Wilshire

Problems we can help solve

Billing Edit Backlogs
Claims Denial
Increased Account Aging
Payment Posting Inefficiencies
Inefficient Processes and Workqueues

How Wilshire Can Help

We solve issues at the source

We evaluate problems holistically, looking upstream to find the issue at its source. Using our unique “One-Touch” approach, we deliver edits requiring manual intervention to the right person at the right time. For charging this includes looking at charge capture methodologies and charge reconciliation processes. For denials this includes reviewing data trends and upstream workflows.

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The Wilshire Group revenue cycle consulting team meeting outside

It’s Better With Wilshire

How your operations will improve

  • Streamlined Edit Resolution
  • Cleaner Claims
  • Efficient Follow-up Workflows
  • Reduced Account Aging
  • Comprehensive Denial Prevention
  • Increased Patient Collections
  • Improved Customer Service
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The Wilshire Group revenue cycle consulting team meeting outside

We Can Improve Your Processes

Professional & Hospital Billing Elements We Consult On

Workflow and Workqueue Optimization
Analyze existing workflows and implement process improvements based on industry best practice.
Candidate for Billing (CFB) Reduction
Review high-dollar and high-volume edits, across functions and systems, to identify root cause and implement backlog resolution plan.
Edit Ownership
Identify owners, users, owning departments and groups for all edits including Charge Review, Discharge Not Billed Edits, Stop Bills, and Claim Edits.
Claims
Optimize claims reconciliation with claims status integration. Review and streamline edits and workflows to maximize the use of tools at your disposal.
Payment Posting
Audit and optimize reason code behavior, increase electronic posting accuracy, improve cash reconciliation, develop better finance integration, and enhance PLB handling.
Denial Management
Perform root cause analysis on top denials and adjustments, correct upstream issues, and set up denials management process to ensure continued success.
Credit Balances
Review patient and insurance credits to identify opportunities to prevent credits from occurring or automate resolution when possible.
Self-Pay Follow-up
Implement strategies tailored to the individual to empathetically collect self-pay balances.
Billing Office Structure and Management
Workflow, role, and tool review to support integration, Single Billing Office implementation, or merger/acquisition activity. Identify repetitive and unnecessary touch points and responsibilities to increase staff efficiency and reduce overhead. Develop a leadership structure to ensure support and accountability.
Patient Financial Experience
Implement improvements to policies, processes, tools, and communication across the organization to ensure a consistent, high quality, patient-centered financial experience.
Dashboards and Reports
Assist with implementation and operationalization of Epic’s reporting suite to gain valuable insights to billing office performance.

We Provide a Framework

Signature Solutions for Your Organization

Take a look at our Quick HIT offerings – short-term, fixed-fee projects with clear ROI to solve your most pressing needs.

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Let’s Connect

Our Service Line leaders will take the time to learn about your challenges and develop a unique approach to solving your most pressing issues.

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