Consulting Services

IRI consultants specialize in all aspects of Revenue Cycle Management (RCM), offering tailored solutions to meet the unique needs of each client. We begin by conducting a comprehensive analysis using best practice Key Performance Indicators (KPIs) to identify areas for optimization in your business operations. Based on our findings, we collaborate closely with your team to implement effective changes and monitor performance improvements.

Our long-term goal is to empower your facility’s management team and staff with the knowledge and confidence needed to maintain improvements after our engagement concludes. We focus on fostering a culture of continuous improvement, ensuring that your team is fully equipped to manage their daily responsibilities with greater efficiency and expertise.

Staffing

Interim leadership
On-site/remote/hybrid
Mentor internal candidates into leadership roles
Restructure middle management

Policy & Procedure Development

Assess Current Processes
- Review existing workflows
- Identify inefficiencies, bottlenecks, and areas of non-compliance
- Gather input from key stakeholders (e.g., billing, coding, finance, and clinical staff)
Define Key Objectives
- Ensure accurate and timely billing and collection
- Maintain compliance with regulatory standards (e.g., CMS, payer rules)
- Maximize revenue and minimize denials
- Improve patient experience and satisfaction with billing processes
Establish Roles and Responsibilities
- Clearly define the duties of each team member involved in the revenue cycle (e.g., coding, billing, collections, etc.)
- Outline reporting structures and escalation protocols
Standardize Workflows
- Establish consistent procedures for managing claims, denials, and appeals
- Create timelines for each task and set expectations for response times
Develop Compliance Guidelines
- Ensure all policies align with industry regulations (e.g., CMS, payer requirements, state and federal laws)
- Include guidelines for maintaining patient confidentiality, proper coding practices, and correct documentation
- Incorporate audit trails and internal checks to prevent fraud and errors.
Review Technology Solutions
- Define the role of software tools (e.g., Claim scrubber, claim submission reconciliation) in supporting the revenue cycle
- Establish procedures for error resolution in automated systems
Denial Management and Appeals
- Develop a standard process for identifying, tracking, and addressing claim denials
- Outline procedures for filing appeals, resubmitting claims, and resolving payment issues
- Include strategies for monitoring denial trends and addressing root causes
Monitoring and Reporting
- Establish KPIs (Key Performance Indicators) to track key revenue cycle metrics, such as Days in Accounts Receivable (AR), claim rejection rates, and collection ratios
- Create reporting mechanisms for department heads and stakeholders
- Define procedures for regular internal audits and performance reviews
Training and Education
- Develop ongoing training programs for staff on policies, procedures, and regulatory changes
- Regularly update employees on new technology, coding updates, payer requirements, and compliance changes
- Offer specialized training for complex areas such as compliance, coding, and appeals management
Continuous Improvement
- Establish feedback loops to identify areas for improvement
- Foster a culture of continuous process improvement through employee involvement and training
Communication and Collaboration
- Set clear communication protocols between departments (e.g., clinical, administrative, finance)
- Establish regular meetings or reports to ensure alignment across the revenue cycle
- Encourage collaboration to address challenges such as claim denials or payer disputes
Documentation and Version Control
- Ensure policies and procedures are clearly written and accessible to all team members
- Use version control to track updates and changes to documentation
- Maintain an audit trail for any changes made to the procedures or policies

Denial Analysis

Root cause analysis
- Fix the issue to prevent on-going denials
- Implement optimal response process
Underpayment review

Audit A/R

Claim creation and submission
Timely follow up
Payment posting
Write-off process

Bridging the Gap

Clinical departments owning revenue generation
- Identify deficiencies
- Education and training
- At the elbow assistance
- Linking clinical documentation to charges to claim forms
EHR Revenue Cycle Optimization
- System build linkages to revenue cycle
- Clinical documentation to charges
- Charges to claim forms
- Claim form to payment posting