In today’s healthcare landscape, where operating margins are tightening and administrative burdens are increasing, hospitals face the critical challenge of ensuring they capture every dollar of earned revenue. While front-end revenue cycle activities like patient registration and back-end activities like billing and collections are often well-monitored, the mid-revenue cycle—a crucial phase that includes utilization management, clinical documentation integrity (CDI), and denials management—is frequently overlooked.
Optimizing the mid-revenue cycle is essential for preventing revenue leakage and maximizing reimbursement. At Brundage Group, we understand the complexities of this critical stage and offer specialized services to help hospitals streamline their processes and capture the revenue they deserve.
The Critical Role of Mid-Revenue Cycle Optimization
The mid-revenue cycle is the keystone connecting clinical care delivery with the financial processes that follow. It involves ensuring that patient care is accurately documented, appropriately coded, and compliant with payor regulations while managing the utilization of hospital resources. This stage directly impacts the accuracy of billing, the effectiveness of denial management, and, ultimately, the hospital’s financial health.
However, mid-revenue cycle departments often operate in silos, leading to inefficiencies and missed opportunities for accurate claim submission. For hospitals to optimize this phase, collaboration across departments is crucial. This is where Brundage Group’s Physician Advisors play a pivotal role.
The Physician Advisor as the “Quarterback” of the Mid-Revenue Cycle
Hospitals need a dedicated Physician Advisor (PA) for each core area of responsibility: utilization management, clinical documentation integrity, and denials management to effectively bridge the gaps between the various mid-revenue cycle departments. These PAs act as “quarterbacks,” promoting collaboration across departments that are often working in isolation.
A dedicated PA in utilization management ensures that patient status is correctly assigned, resources are used efficiently, and care is delivered in compliance with payor requirements. This prevents costly denials and ensures that hospitals are reimbursed appropriately for the care provided.
Accurate and comprehensive clinical documentation is the foundation of proper coding and billing. A PA focused on CDI and coding works closely with physicians, CDI, and coding staff to ensure that the documentation reflects the complexity of care delivered. This supports accurate reimbursement and mitigates the risk of audits and penalties.
Denials are a significant source of revenue leakage for hospitals. A PA dedicated to denials management can proactively identify trends, address root causes, support creation of appeal letters, and lead peer-to-peer discussions with payors to overturn denials. This reduces the burden on clinical staff while improving hospital finances
How Brundage Group Helps Hospitals Capture Earned Revenue
At Brundage Group, our team of seasoned Physician Advisors brings a wealth of expertise in mid-revenue cycle optimization. Our holistic approach focuses on utilization management, CDI, and denials management to ensure that hospitals capture every dollar of earned revenue.
In a time when every dollar counts, optimizing the mid-revenue cycle is essential for hospitals to remain financially viable. Hospitals can significantly reduce revenue leakage and maximize reimbursement retention by ensuring collaboration across utilization management, clinical documentation integrity, and denials management.
Brundage Group’s dedicated Physician Advisors are the key to unlocking this potential, serving as the “quarterbacks” who drive collaboration and efficiency across the mid-revenue cycle. With our support, hospitals can capture their earned revenue and strengthen their financial health in a challenging healthcare environment.
