The revenue cycle is the process that starts with a patient’s initial appointment and ends with full payment for services. It encompasses all the administrative and clinical functions that contribute to collecting patient service revenue. For healthcare organizations that provide services to patients, the revenue cycle is the organization’s financial lifeblood.
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“There is no silver bullet to solving medical necessity risks as they relate to medical claims submitted to payers such as Medicare. That said, these tips can be a starting point for compliance programs who know they need to minimize their compliance risk around medical necessity.”
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“Revenue cycle management compliance is crucial for the financial health and operational success of healthcare providers. By adhering to regulatory standards, ensuring accurate billing and coding, and protecting patient information, healthcare facilities can avoid legal repercussions and maintain patient trust.”
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“My success in uncovering millions of dollars in unbilled services demonstrates how revenue protection is a tangible way Compliance delivers value to healthcare organizations. It also underscores how compliance professionals make an impact across the business through building relationships, shaping culture, preventing fines, and positioning Compliance as true partner.” – Maeve O’Neill
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Urine drug testing overpayments drove up to $216 million in overpayments to Medicare over five years, according to a recent OIG audit report.
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Protect healthcare revenue: reduce the risk of fines and payback for inappropriate outlier payments created by unjustified price increases.
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Build relationships with these key clinical and operational areas – Nursing, Physicians, Revenue Cycle, IT, Sales and Marketing. Help them achieve their goals.
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Complex and billed at a higher rate, OIG added physicians billing for critical care evaluation and management services to the work plan.
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Avoid this million-dollar monitoring mistake. Help clinical colleagues apply their expertise to your scalable, repeatable healthcare compliance processes.
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