Services
Health Evolutions utilizes an integrated approach for addressing revenue cycle start-up, evaluation, and improvement needs by providing consultants with specific expertise in finance, managed care, and operations as needed to assist clients in this critical area. Our consultants have set up and run hospitals, group practices, MSOs and PHOs, managed care plans, and HMOs and understand the fundamental requirements and obligations to assure sufficient cash flow through a well-run and organization-specific revenue cycle process.
Health Evolutions' approach to managed care contract compliance involves measuring the performance of managed care entities against specific contract terms and negotiated rate amounts to determine accuracy and appropriateness of plan payment decisions.
Health Evolutions' approach to developing managed care strategies gives hospitals the information they need to be successfully proactive. This strategic positioning includes an analysis of public and proprietary data supplemented by interviews of employer, payer, physician, and management. Specific strategies are developed based on the market characteristics and findings.
Health Evolutions' consultants review a large number of managed care agreements annually. These reviews are based on a set of proprietary contracting guidelines developed by Health Evolutions in conjunction with our clients.
Health Evolutions works with clients to assess and improve revenue cycle operations and financial outcomes based upon the organization's needs. Utilizing key operational, performance, and financial indicators, as well assessing workflow and processes, the revenue cycle is examined from point of patient entry through to successful account closure. Opportunities for improvement are identified and necessary steps are taken to improve financial and process outcomes.
This program is a mechanism by which schools can secure the federal share of Medicaid reimbursement for the documented time spent by school personnel to locate, identify, refer, and coordinate health and health-related services for Medicaid-eligible students and their families. Health Evolutions' services include technology solutions, web-enabled tools to promote efficient and effective participation in Medicaid, and consulting services to design and implement Medicaid reimbursement programs.
Health Evolutions' approach to managed care contract negotiation assistance can involve everything from analysis of data and development of negotiating strategies and tactics to the actual face-to-face negotiations with managed care plans.
"The Provider-Based Rule (PBR) has far reaching implications for hospitals. There is significant confusion regarding the rule, and when and how to comply because of frequent changes by the Centers for Medicare and Medicaid Services (CMS). By law, non-compliance enables CMS to recoup past Medicare payments, as well as decrease future payments.
The Health Evolutions three-phase PBR Assessment and Compliance Evaluation (ACE) is a streamlined approach to determining a hospital's PBR compliance status and what the hospital should do about it."
Health Evolutions risk product assessment includes an actuarial-based analysis of benefit design, unit cost data, and utilization assumptions to determine the adequacy of proposed capitation rates and risk pool funding compared to anticipated medical expenses.
Health Evolutions can help analyze a hospital's internal managed care capabilities by evaluating the hospital's strategy, intelligence gathering, contracting process, revenue cycle management, and resource management.
Health Evolutions provides a transfer rule analysis to determine how much money is being lost due to the newly expanded transfer rule. This analysis includes review of the DRGs for potential loss of Medicare reimbursement due to transfers to post-acute providers prior to the GMLOS (geometric mean length of stay).
areas of expertise
- Surgery
- Specialty Hospitals
- Physician Services
- Orthopedics
- Neurosciences
- Imaging
- Cardiovascular
- Ambulatory
