Consulting


Over 16 years of helping healthcare providers improve their revenue outcomes, we’ve learned that collaborating with clients yields the best results.

We have experience with the challenges of the administrative, revenue management, and clinical aspects of many specialties, including oncology, radiology, and orthopedics. With data analytics and expertise, we assist in developing effective strategies supported by clinical and operational evidence.

Our experienced consultants provide coaching for healthcare executives to implement action plans to improve performance.


Vendor Negotiations
We can assist in the planning, expansion, developing, and purchasing of new equipment, centers, drugs, etc. Understanding regional and national data allows you to leverage what is optimal for you and your facility, from service contracts to capital purchases. Ensure you have a partner that understands all aspects.
Data Review and Strategy Build
Providers, practices, and physicians often want to know where they stand and how they compare with regards to:
  • Financials
  • Salaries
  • Costs
  • Spending
  • Volumes
  • Staffing

  • We use your data from the various systems to create a relational roadmap for what you are looking for. This data is then applied to variable adjusted models to test impacts and outcomes based on your predictions and specified parameters.
    Specialty Pharmacy Set up
    It sounds like a great revenue stream. But launching and successfully operating a specialty pharmacy requires much experience and expertise. You must consider a myriad of requirements before moving forward. Our team can assist in this process. We also help those considering infusion center start-ups and infusion-specialty pharmacies. We assist in guiding you through the considerations needed for:
  • 503B
  • USP 797 guidelines
  • ASHP rules
  • Revenue Integrity & Optimization
    Our expert technology enabled team will work with you and your existing RI program or assist you in developing one.
    Areas of focus:
  • Point of service collections
  • Workflow analysis
  • Compliance
  • Narrow gap between clinical coding and revenue cycle / CBO Coding productive performance- not just adding FTEs

  • There are numerous indicators that should be reviewed from the data and actionable/relational items created from:
  • DNFB- track, prioritize, and clear queue
  • Denials
  • Avoidable write offs
  • Underpayment recovery
  • Patient volume leakage
  • Halo revenue streams
  • Operations
  • Advisory, accountability, and strategic board development
  • Financial responsibility mapping
  • Service and software contract negotiation
  • Market assessment and referral pattern identification
  • Financial operations monitoring down to GL account oversight
  • Advance payer relations and contract negotiations
  • Technology-enabled authorization strategies
  • End-to-end RCM management, oversight, and operation
  • Resource utilization costing and reporting
  • Advance quality management and Accreditation Program Assistance
  • Radiation Oncology
  • Risk assessment audits
  • Billing, coding compliance Services
  • Prior Authorization
  • Purchasing
  • Mergers and Acquisitions
  • Employment models
  • Value-based care
  • RO APM
  • Patient Benefits And Financial Navigation
    We specialize in creating a lockdown benefits and financial navigation team.

    Whether starting from scratch:
  • Hiring
  • Training
  • Policies and Procedures
  • Tracking
  • Patient Communication Templates
  • Effective Software Utilization Review
  • Ongoing Education Portal

  • We ensure that there is standardization in this role and that it is properly defined. We understand the significance of this role and the impact that it has on the patient care path as well as the providers financial viability. Our team members have served in these roles and developed these programs for over 5 years.
    We even have the ability to supplement your current staff in this role with ours so they can learn in process with use case scenarios that are unique to them and their patient population.
    Partners
    Our team of experts can assist you in effectively utilizing these roles. These roles should not be viewed as a cost center but as a revenue stream. Understanding the importance and impact these roles have on patient care and financial viability is our focus and what we assist you in articulating with stakeholders. We provide services and expertise for:
  • Vendors
  • Payers
  • Providers
  • Networks
  • Ancillary staff
  • Physicians and more
  • Specialty Topic Consulting
  • Remote/Onsite E&M Reviews
  • Audits based on the 2021 E/M
  • Documentation rules (99202-99215)
  • Other outpatient visits and based on the 1995/1997 Documentation Guidelines
  • ICD-10 Documentation Reviews for Risk (combination and laterality)
  • Surgical - Professional Coding and Documentation
  • Improvement
  • Orthopedics - Professional
  • Coding and Documentation Improvement
  • GI- Professional Coding and Documentation Improvement
  • ICD-10 Sequencing (Oncology)
  • Risk Adjustment
  • HCC Coding
  • Auditing
  • Outpatient CDI