Optimize your reimbursements and improve efficiency with tailored services like fee structure analysis, cost reporting, denials management, and KPI dashboarding.
Revenue cycle optimization and internal control assessment
AAFCPAs performs internal control reviews of the revenue cycle operation to help clients capture more revenue. This involves assessing the controls and procedures from the front end through the back, and all the various layers in between in the collection of accounts receivable. We perform analysis of your insurance verification process, authorization & re-authorization process, timing of billing, and collection follow-up. We take an objective and subjective look at your people, process, and technology and make pragmatic and best practice recommendations in areas where healthcare organizations may increase reimbursement and improve revenue cycle management efficiency.
Revenue cycle optimization and reimbursement integrity
Healthcare organizations operate in a complex reimbursement environment where rate structures, payer rules, compliance requirements, and operational performance all directly impact financial outcomes. AAFCPAs helps providers evaluate fee structures, strengthen compliance with HRSA and payer requirements, reduce preventable denials, and improve revenue cycle performance through data-driven insights, reporting, and process optimization.
We review current medical, behavioral health, and dental fee structures to assess the adequacy of rates charged and provide rate-setting recommendations to support appropriate reimbursement and pricing integrity.
AAFCPAs assists clients in calculating medical rates and optimizing collection in accordance with HRSA’s Sliding Fee Discount and Related Billing and Collection Program requirements. We support ongoing organizational compliance, including documentation of policies and procedures aligned with HRSA program expectations, and help clients avoid issues related to an HRSA Operational Site Visit.
AAFCPAs has extensive cost reporting and reimbursement experience with both cost-based and Prospective Payment System (PPS) providers. We understand the importance of cost reports for healthcare organizations and provide guidance to support accurate preparation, clarity on key reporting objectives, and awareness of areas of regulatory scrutiny. We also conduct training sessions for associations on best practices to reduce preparation effort while ensuring reports accurately reflect cost of care and support appropriate reimbursement.
Most denials are driven by inefficient processes and can often be prevented. Denials may result from internal issues, technology gaps, or billing complications with third-party payors. Interpreting payer billing and coding requirements can be complex. AAFCPAs identifies opportunities to reduce denials and improve reimbursement by analyzing root causes and identifying recurring trends. When denials stem from internal factors, we provide training to prevent recurrence. When caused by external payer issues, we help clients develop an action plan to address them with insurers. We leverage our Data Analytics team and advanced data mining tools to evaluate large and complex datasets across disparate systems.
AAFCPAs helps healthcare organizations monitor the health of their revenue cycle through data analysis and visualization. This includes identifying appropriate key performance indicators (KPIs) to support decision-making. Our in-house data analysts work with client teams to extract, inspect, cleanse, and model data to enable near real-time visibility into revenue cycle performance, financial trends, and operational efficiency.
Driving successful healthcare partnerships and integrations
Working closely with healthcare organizations, we have witnessed dramatic changes in the industry, including the current consolidation landscape and integration of behavioral health into the primary care delivery system. Our specialists are well-prepared to advise clients on forging innovative partnerships or consolidations that will improve the quality of care and clinical outcomes while controlling costs. We help clients to perform well-executed integrations that optimize both outcomes and profitability. This includes:
Vetting potential healthcare partnering arrangements, including comparative analysis of competition, cost structures & payment methods, practice patterns, quality of care, and clinical outcomes.
Guidance on changes in reimbursement and regulatory frameworks and the increased proliferation of high-deductible health insurance plans.
Analysis of Accounts Receivable & Third-Party Reimbursement.
Optimizing ROI on technological investments and aligning business process controls with performance objectives.
Guidance on improving processes and leveraging systems to streamline reporting and compliance requirements.
Development of tracking and monitoring systems for risk-based contracts. This involves determining the costs for providing the services to be covered under the contract. In addition, we also help to develop a system to monitor the services being provided and costs involved. The profit/loss on these contracts needs to be determined as well as how much is attributable to the organization. We consult on the level of reserves that are necessary for these contracts, and the accounting and financial reporting requirements.
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