Some of the Projects we offer!
1. Critical Access Hospital Revenue Cycle Optimization Assessment
Project Overview
HRS will assess the hospital’s complete revenue cycle to identify opportunities to improve revenue capture, efficiency, reimbursement, and financial performance. The assessment will focus on the unique needs of Critical Access Hospitals (CAHs) and applicable Rural Health Clinics (RHCs), using data analysis, interviews, workflow review, and financial evaluation to identify revenue leakage, inefficiencies, compliance risks, and improvement opportunities.
Scope of Assessment
HRS will evaluate key components of the organization’s revenue cycle, including:
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Scheduling and patient access
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Registration accuracy and demographic capture
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Insurance eligibility and verification
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Prior authorization processes
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Point-of-service collections
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Clinical documentation and charge capture
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Health Information Management (HIM)
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Coding and billing workflows
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Claim generation and submission
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Clean-claim performance
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Payment posting and reconciliation
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Denial prevention and management
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Accounts receivable and patient collections
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Revenue integrity and Charge Description Master processes
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Revenue cycle reporting and key performance indicators
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Provider-based RHC revenue cycle processes, when applicable
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EHR and revenue cycle technology utilization
HRS will also evaluate the relationship between clinical operations and financial performance to identify missed or delayed charges, documentation gaps, coding delays, claim errors, and other sources of revenue leakage.
Deliverables
At the conclusion of the assessment, the participating CAH will receive:
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Comprehensive Revenue Cycle Assessment Report
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Baseline Revenue Cycle KPI analysis
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Identification of revenue leakage and operational improvement opportunities
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Workflow and technology optimization opportunities
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Prioritized findings based on financial and operational impact
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Recommended performance benchmarks and monitoring measures
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30-day immediate action plan
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90-day performance improvement roadmap
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12-month strategic improvement plan
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Executive presentation of findings and recommendations
When provider-based RHCs are included, findings will identify hospital- and RHC-specific opportunities and their impact on overall CAH financial performance. Baseline measures will be established using current organizational data, with improvement targets developed based on baseline performance and identified opportunities.
2. Critical Access Hospital Revenue Integrity Assessment
Project Overview
HRS provides a comprehensive Critical Access Hospital Revenue Integrity Assessment designed to identify opportunities to strengthen charge capture, improve documentation and coding alignment, reduce revenue leakage, enhance regulatory compliance, and ensure that services provided are accurately translated into appropriate reimbursement.
Revenue integrity extends beyond the traditional billing office. Effective revenue capture begins within the clinical and operational departments where patient services are ordered, performed, documented, coded, and ultimately converted into charges. HRS utilizes a clinically driven approach that brings together clinical operations, finance, coding, revenue cycle, information technology, and executive leadership to evaluate the complete process from service delivery through reimbursement.
The assessment is designed specifically to identify gaps between clinical activity and financial outcomes and provide hospital leadership with a prioritized, actionable strategy for improving revenue integrity while supporting compliant billing practices.
Scope of Assessment
HRS will evaluate key components of the organization's revenue integrity processes, including:
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Charge Description Master (CDM) structure and maintenance processes
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Charge capture workflows
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Clinical documentation supporting charges
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CPT/HCPCS and revenue code alignment
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Modifier utilization
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Department-specific charging practices
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Manual versus automated charge capture
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Missing, delayed, or duplicate charges
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Coding and documentation dependencies
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Medical necessity and billing edits, where applicable
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Revenue cycle and clinical system workflows
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Departmental reconciliation processes
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Revenue integrity reporting and monitoring
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Policies and procedures supporting charge capture
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Staff education and accountability
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Provider-based Rural Health Clinic processes, when applicable
Clinical and ancillary departments may include areas such as emergency services, laboratory, radiology, rehabilitation, respiratory therapy, pharmacy, surgery, infusion services, observation, specialty clinics, and other departments based upon the services offered by the participating CAH.
Deliverables
At the conclusion of the engagement, the participating CAH will receive:
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Comprehensive Revenue Integrity Assessment Report
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Charge Description Master findings and recommendations
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Identification of potential revenue leakage and charge capture opportunities
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Department-specific workflow findings
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Identification of documentation and coding gaps affecting charge capture
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Review of manual and automated charging processes
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Identification of compliance and revenue integrity risks
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Prioritized recommendations based upon financial and operational impact
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Recommended revenue integrity KPIs and monitoring processes
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Departmental education opportunities
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30-day immediate action plan
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90-day improvement roadmap
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12-month revenue integrity strategy
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Executive presentation of findings and recommendations
3.Critical Access Hospital Charge Master Review & Optimization
Project Overview
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HRS provides a comprehensive CAH Charge Master Review & Optimization designed to improve the accuracy, consistency, compliance, and financial integrity of the hospital's Charge Description Master (CDM). The CDM links clinical services, operations, coding, billing, reimbursement, and financial reporting; inaccurate or outdated structures can contribute to lost revenue, claim edits and denials, inconsistent charging, reimbursement issues, and compliance risk.
HRS will conduct a structured review of the existing CDM and maintenance processes to identify coding discrepancies, outdated or inactive items, inconsistent charge structures, revenue code concerns, pricing anomalies, and opportunities to strengthen CDM governance. The engagement is designed for the operational and reimbursement environment of CAHs and may include provider-based departments and clinics, as appropriate.
The objective is to provide the CAH with an accurate, manageable, and sustainable CDM supported by defined maintenance processes and organizational accountability.
Scope of Review
HRS will evaluate:-
CDM structure, organization, CPT/HCPCS assignments, revenue code alignment, charge descriptions, active/inactive items, duplicates, units of service, and departmental ownership
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Charge consistency, pricing relationships and anomalies, Medicare charging considerations, coding and billing dependencies, and claim edits associated with CDM configuration
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Charge capture relationships between clinical departments and the CDM
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CDM maintenance, annual updates, internal controls, and approval processes for adding, modifying, or retiring charges
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Departmental responsibility and accountability for CDM accuracy
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EHR configuration and technology supporting CDM maintenance and charge generation
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Where appropriate, HRS will work with clinical and ancillary leaders to validate that CDM items accurately represent the services, procedures, supplies, medications, and resources currently provided.
Deliverables
At the conclusion of the engagement, the participating CAH will receive:-
Comprehensive Charge Master Review Report with detailed findings and recommended modifications, including coding/revenue code discrepancies, duplicate/outdated/inactive items, pricing anomalies, revenue capture opportunities, and department-specific findings
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CDM Governance Recommendations addressing maintenance, adding/modifying/retiring charges, departmental accountability, and supporting processes
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Prioritized Corrective Action Plan distinguishing immediate corrections from items requiring additional departmental, coding, compliance, technology, or leadership review
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Executive Summary and Presentation
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4. Rural Health Clinic Financial & Operational Optimization
Project Overview
HRS provides a comprehensive RHC Financial & Operational Optimization project designed for provider-based RHCs operated by Critical Access Hospitals. The project evaluates financial, operational, revenue cycle, reimbursement, and compliance processes to identify opportunities to improve performance while strengthening the financial sustainability of the parent Critical Access Hospital.
RHCs operate within a unique reimbursement and regulatory environment requiring alignment among clinical operations, provider practices, revenue cycle processes, Medicare reimbursement, cost reporting, and compliance. HRS combines specialized RHC knowledge with CAH and revenue cycle experience to evaluate these interconnected areas rather than assessing clinic billing in isolation.
The objective is to provide CAH and RHC leadership with a practical understanding of current performance, identify financial and operational improvement opportunities, and establish a measurable roadmap for improving efficiency, reimbursement, compliance, and long-term sustainability.
Scope of Assessment
HRS will evaluate key components of participating provider-based RHC operations, including:
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RHC revenue cycle workflows, scheduling, registration, eligibility, and prior authorization
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Provider enrollment, credentialing, clinical documentation, coding, and charge capture
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RHC billing requirements, claim submission, Medicare reimbursement, and Medicaid/commercial payer considerations
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Denials, accounts receivable, payment posting, and reconciliation
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Provider productivity, clinic utilization, staffing, and workflow efficiency
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Cost report processes and supporting operational data
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Allocation and reporting considerations affecting RHC financial performance
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Regulatory and compliance processes
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EHR utilization and workflow optimization
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Financial and operational reporting, KPIs, and leadership accountability
The assessment will also examine how RHC operations affect the financial performance of the parent CAH and identify opportunities to strengthen coordination among all members of the revenue cycle management division.
Deliverables
At the conclusion of the engagement, the participating CAH and RHC will receive:
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Comprehensive RHC Financial & Operational Assessment Report
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Baseline financial, operational, and KPI analysis
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Revenue cycle, reimbursement, revenue leakage, workflow, productivity, and utilization findings
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Documentation, coding, billing, denial, cost report, compliance, and operational improvement findings
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EHR and technology optimization recommendations
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Recommended RHC financial and operational KPIs
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Prioritized corrective action plan, including 30-day priorities, 90-day performance roadmap, and 12-month optimization strategy
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Executive presentation of findings and recommendations
For CAHs operating multiple provider-based RHCs, HRS may compare clinics to identify variations in workflows, productivity, revenue cycle performance, and operational practices and recommend greater organizational standardization.
5. Critical Access Hospital Patient Access Improvement
Project Overview
HRS provides a comprehensive CAH Patient Access Improvement project designed to strengthen the front end of the revenue cycle through improved registration accuracy, insurance verification, authorization processes, patient financial communications, point-of-service collections, and coordination among patient access, clinical departments, and revenue cycle operations.
Patient access is an early opportunity to prevent revenue cycle delays and avoidable denials. Inaccurate demographic or insurance information, incomplete eligibility verification, missing authorizations, inconsistent registration, and ineffective communication of financial responsibility can cause rework, delayed reimbursement, denials, and lost revenue. These standardized processes are particularly important for rural organizations where limited staffing often requires employees to perform multiple functions.
HRS will evaluate current patient access operations and develop practical, measurable recommendations to improve accuracy, efficiency, patient experience, and financial performance. The project may include hospital departments, outpatient and emergency services, and provider-based Rural Health Clinics based on the participating CAH's structure, priorities and requests.
Scope of Assessment
HRS will evaluate:
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Scheduling and Registration: Scheduling, preregistration, demographic and insurance data collection, Emergency Department, outpatient/ancillary, and provider-based RHC registration and scheduling, when applicable
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Eligibility, Authorization & Medical Necessity: Eligibility and benefits verification, prior authorization/precertification, medical necessity and order-related workflows, referrals, and provider orders
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Financial Responsibility & Collections: Patient responsibility identification, estimates, financial communications, and point-of-service collections
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Quality & Revenue Cycle: Registration quality assurance, error monitoring, registration and authorization-related claim edits and denials, and front-end causes of preventable denials
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Staffing & Workflow: Staff roles, responsibilities, workflow distribution, policies, procedures, standardized workflows, and opportunities to reduce duplicate work and manual processes
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Technology & Coordination: EHR functionality, work queues, alerts, automation, patient access reporting/KPIs, and communication and handoffs among patient access, clinical, and revenue cycle teams
Deliverables
At the conclusion of the engagement, participating CAHs will receive:
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Comprehensive Patient Access Assessment Report including current-state workflows, baseline KPIs, registration quality, eligibility, insurance verification, authorization, financial communication, and point-of-service collection findings
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Denial, Workflow & Efficiency Findings identifying preventable front-end denials, staffing/workflow opportunities, process variations, and opportunities for organizational standardization
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EHR & Technology Recommendations addressing functionality, automation, work queues, alerts, reporting, and monitoring
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Standardized Patient Access Recommendations including workflows, KPIs, monitoring processes, and staff education/competency opportunities
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Prioritized Improvement Plan including a corrective action plan, 30-day immediate actions, 90-day performance roadmap, and 12-month Patient Access optimization strategy
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Executive Presentation of findings and recommendations
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