Revenue Cycle and Management

Kohler Healthcare has assisted over 750 hospitals, surgical centers, imaging centers, and physician practices to improve their operations and effectiveness while maintaining and improving compliance. Our consulting services are based on the specific needs of your organization, we deliver an individualized approach to solve your business problems.

Many of our clients utilize a broad array of our service offerings for the multiple aspects of the functional areas within the revenue cycle. We bring our qualified consultants to handle the issue – clinical, operational, and departmental issues such as Professional Services, Post-Acute Services, Emergency Services, Peri-operative Services, Clinical Departments, and the many support Services – Pharmacy, Laboratory, Supplies, and Case Management, Clinical Documentation Improvement.

Advisory Assistance - AA

With the constantly changing regulatory landscape, complex questions can arise that require subject mater experts to provide guidance on topical maters. Receiving authoritative and timely answers is often needed and needed immediately. When issues arise and answers are needed quickly, KHC can efficiently review and respond to your request with clear and concise guidance with regulatory support. As many clients do not require large project assistance but may require immediate short-term advisory assistance on a specific topic; the Annual Assistance Program provides an option for specialized advisory services. Our advice is practical as many of our consultants have worked in the healthcare industry. Our clients benefit from this fast access to the talent and resources required to solve their business problems

Revenue Cycle – Front End, Mid-Cycle and Back End

KHC offers a portfolio of services that provide a unique and integrated approach to Revenue Cycle Management. Our service offerings combine the clinical care management function with the range of financial activities that included the full continuum of the entire revenue cycle phases.

Establishing a performance baseline is key in understanding processes that are effective as well as those processes that require a focused review and redesign. Understanding management concerns with the entire process is embedded in this approach. However, strategic improvement is most otien the best use of limited resources, and we pinpoint the highest priority areas for improvement that generate the greatest financial return.

Our revenue cycle services promote functionality and compliance with applicable laws, regulations, and industry best practices from appointment to collection/adjudication including improved process and technology and training. Understanding that different payers have different rules and regulations, ourpolicies and procedures work to provide clarity.
Specific services include:

  • Process and functional workflow improvement
  • Regulatory basis for specific services and required documentation and coding
  • Coding and billing requirements including NCCI and payer edits
  • Deep departmental documentation development, training, and identification of billable services
  • Scheduling and pre-authorization set up infrastructure development
  • CDM and fee schedule development and fee schedules
  • Training and education on all facets of the revenue cycle and revenue integrity
  • Payer and collection guidelines
  • Staffing and functional departmental structural review
  • Interim assistance

Coding and Billing Review

Over the past 15 years, KHC has garnered deep and broad experience performing Professional Coding audits in a wide variety of medical specialties and healthcare environs.

As a component of healthcare compliance programs, developing approaches to measure billing accuracy in the revenue cycle is highly dependent on performance metrics. Utilizing tools to evaluate coding and billing activity to identify trends, aberrations, or areas of concern for follow up and monitoring is part of the revenue cycle integrity component.

From these types of reviews, KHC results have been utilized by our clients to improve processes, internal controls and serve as the basis for provider education to improve financial performance within the context of compliant coding and billing.

Hierarchical Condition Categories – HCC

Value-Based payment models are maturing, and every provider will need to be proficient in Hierarchical Condition Categories (HCC) HCC Coding. HCC coding is dependent on medical record documentation and an understanding of how certain diagnoses codes represent increased care need of patients. KHC can help in the development of your HCC program including monitoring and auditing.