Health System Solutions (HSS) is a joint venture between Guidehouse, and Baptist Health South Florida. HSS provides revenue cycle management services to providers.
The combination of Guidehouse’s strong market position in outsourced revenue cycle management and Baptist Health South Florida, as an internationally renowned center of excellence for healthcare services, creates an exceptionally strong company to compete in the ever-changing healthcare services industry. This entity will help healthcare services providers defend, protect, and create value in the midst of transformational change or when facing significant regulatory or legal pressures.
Our revenue cycle outsourcing includes comprehensive revenue cycle management as well as several modular services we can deploy independently, based on client interest and need. Our end-to-end revenue cycle solution addresses front-end, mid-revenue cycle, and back-end functions that holistically secure revenue that might otherwise be lost. We tailor our offerings to the client’s needs and provide highly-trained staff that employ best in class technologies and optimize process flows to ensure the most efficient and effective reimbursement capture. Like our comprehensive solution, our modular offerings address all phases of the revenue cycle with an emphasis on coding and insurance follow-up.
Front-end patient services that are used prior to the delivery of clinical services, set the stage for full and prompt payments after care is provided. The patient access department serves a critical role in provider organizations as it interacts with every patient through the registration, insurance verification and cash collection process. Due to increased pressure to enhance patient experience, healthcare organizations need to improve their patient access services by employing best practice workflows through the implementation of technology, processes and highly trained personnel.
Patient access services are enhanced using our trained staff who use best practices and technology for the following functions:
- Self Service Pre-Registration - Allowing patients to get an estimate of charges and patient out of pocket amounts for scheduled procedures, helps patients make better decisions about their healthcare.
- Text/Email Appointment Reminders – Helping in the reduction of “no-show’s” for appointments.
- Concierge Check-In – Allowing for patients who pre-register with the self-service portal to access concierge check-in.
The middle section of the revenue cycle should be designed to ensure that the data collected and used for payments is robust, correct, and up-to-date. The Health Information Management (HIM) department serves a critical role in provider organizations in the collection and retention of clinical and financial data. As healthcare organizations grow with an emphasis on performance excellence and business strategy, accurate coding and clinical documentation integrity are paramount to an organization’s financial success and longevity. Our credentialed clinical coders and certified management staff enable our clients to receive accurate reimbursement.
HIM services are enhanced using our trained staff who use best practices and technology for the following functions:
In conjunction with HIM, revenue integrity operates in the middle section of the revenue cycle and is used to ensure that the data used for payments is robust and up-to-date. The revenue integrity department serves a critical role in provider organizations for the accurate documentation of clinical services, translating these into reimbursable offerings. We design and implement processes to monitor revenue and identify, correct, and optimize the processes and systems that lead to lost revenue.
Revenue integrity services are enhanced using our trained staff who use best practices and technology for the following functions:
- Pre-bill analysis in addition to standard post-bill review
- Proprietary, intuitive charge capture practice algorithms
- Intelligent workflow capabilities
- Immediate gross and net revenue impact
Charge capture technology helps determine where and why revenue is not being captured to implement processes that address the root cause. This gives clinical and finance leadership confidence that the health system is capturing the appropriate revenue for services rendered.
These functions, when done correctly can ensure that clinical services translate into financial compensation for providers and help prevent denials.
Back-end patient account resolution services guarantee full and prompt payment after care is provided. The patient financial services (PFS) department serves a critical role in provider organizations to ensure the full and timely collection of payments. As healthcare providers look for ways to achieve the full potential of their revenue cycle, it is vital to increase collections and obtain timely and accurate reimbursement on every patient account. As a leading extended business office services provider, our accounts receivable management team members extend the capabilities of your business office to gain efficiencies and reduce accounts receivable.
PFS services are enhanced using our trained staff who use best practices and technology for the following functions:
- Aged Accounts Receivables (A/R) – Our team members apply government and national payer experience for accurate and timely reimbursement and use analytics to provide summary and detail-level reports to complement a process of consistent and standardized follow-up for aged accounts
- Low-Balance A/R – For low-balance accounts, our team members use similar processes and technologies for consistent and standardized follow-up
- A/R System Conversion – We utilize technology-enhanced processes to efficiently resolve accounts receivable from the legacy system, enabling the healthcare organization to focus on the implementation and training efforts involved in deploying the new system. Our solution assists in achieving a faster sunset of the legacy system while maintaining cash flow and improving provider resource utilization
- Patient segmentation
- Insurance scrubs
- Bankruptcy & deceased scrubs
- Payment plans
- Single billing office (for hospital and physician billing)
- Payment portal
-Patient satisfaction surveys