Health Care Professional Consulting Services, Inc. (HCPCS)
Improving Cash Flow, Reducing Administrative Costs

Post-acute health care providers are seeing a paradigm shift with greater focus on value based care reimbursement programs and increased emphasis on patient outcomes and expectations of satisfaction. In addition, enhancements to revenue for cash flow and reduction in administrative expenses are critical to profitability and proper management. Health Care Professional Consulting Services (HCPCS) is instrumental in translating these aspirations into reality by helping clients navigate the dynamic payment models as well as effective revenue cycle management. By providing the needed tools and resources to streamline operational workflows; provide training; and increase efficiency, providers can easily adapt to the evolving reimbursement models. A tangible reduction in the risk of bad debt is achieved by strategically deploying specialized processes, disseminating critical reimbursement knowledge, training existing provider staff or providing outsourced billing for their organization as part of the consulting partnership.

“We uplift our partners, by keeping them informed about upcoming changes and opportunities. Nationally, there is a shift from Medicare fee for service to Managed Care and value based approach underway. As change agents, we make sure that clients grasp the future and prepare effectively,” says Julie Ann Kemman, President and CEO of HCPCS.

One of the most noteworthy outcomes of Kemman’s approach is the remarkable improvement in claim payment turnaround times. HCPCS ensures optimized revenue cycle from the onset, beginning with the front-end admissions process by aiding partners in understanding their contracts, eligibility practices, authorization requirements, and clean claim turnaround. This includes the meticulous identification of payer guidelines, carve-outs, and other revenue-enhancing opportunities.

HCPCS takes a proactive stance in managing the complexities of the managed care value based landscape. This involves diligently adhering to the unique compliance requirements imposed by different payers. Through this targeted focus, the company provides invaluable support to providers, guiding them through the intricacies of diverse payer expectations and ultimately contributing to their sustained success and increased cash flow.

Comprehensive internal control reviews are performed when engaging with clients.

This process begins with evaluating the business operations including admission procedures, ensuring a seamless flow of process for downstream, particularly concerning collections, and minimizing denial management. The emphasis lies in establishing effective processes for communication right from the moment of admission. The company extends its support throughout this journey, encompassing billing, collection efforts and proficient management. This involves addressing partial payment, recoupment projects, and utilizing their adept management approach.

By strategically tackling issues related to appeal processes and clean claim billing through training and EMR configuration, HCPCS actively mitigates the challenges posed by turnover and attrition, which otherwise may lead to the erosion of valuable knowledge and expertise in revenue cycle management for the post-acute health care provider.

Another notable challenge arises when providers fail to respond to requests for records or project reviews, jeopardizing proper reimbursement for the care provided. This situation could lead to reimbursement being clawed back. The company mitigates this risk by facilitating effective communication and cooperation between providers and requests thus safeguarding the entire process.

We uplift our partners, keeping them informed about upcoming changes. Nationally, there's a Medicare-to-managed care shift underway. As a change agent, I make sure that clients grasp the changes and prepare effectively

Recently, HCPCS has encountered clients with overdue balances beyond 90 days, seeking guidance on effective collections and staff accountability. The team successfully conducted AR reviews, rectified claim denial issues, provided tools and training to substantially increase cash collection and reduce A/R days sales outstanding. We tailored our approach to each provider’s needs for training to empower leadership and staff to navigate payment discussions across various payer types. HCPCS excels in renegotiating managed care plan contracts, bolstering providers' revenue, and understanding quality care delivery focused reimbursement programs.

Medicaid application support is also provided by HCPCS, aiding patients in accessing these benefits and making way for providers to have a viable payer source. It further assists providers in navigating enrollment and contracting during change of ownerships. This includes running out accounts receivable and acting as a liaison to ensure stability amid these transitions.

HCPCS transforms healthcare facilities into efficient, financially sound, and patient-focused operations. Its strategic guidance, streamlined processes, and expertise in navigating complex payment models, empowers its partners to adapt to evolving reimbursement landscapes. By optimizing revenue generation, improving claim payment turnaround times, and helping clients with compliance, it contributes to sustained success for healthcare providers.