Netsmart’s
Plexus
Revenue Cycle
Management
TM
Improves
Financial
Performance
Netsmart’s
Plexus Revenue Cycle Management
TM
Improves Financial Performance
The healthcare landscape is evolving at the speed of
thought, and providers are being forced to shift at an equal
pace operationally, clinically…and also financially. There are
innumerable strains on healthcare providers’ revenue cycle
management as plans enter and exit markets, payment
criteria moves from fee-for-service to pay-for-performance,
payers change coverage rules and the government adds
new payment codes and methodologies.
To compete, healthcare providers need to proactively
manage these shifts. Mastering your revenue cycle will help
ensure sustainability.
The five greatest challenges of revenue cycle management are:
• S taying current with payer requirements
• Verifying client eligibility
•M
onitoring the entire claims process
•R
esubmitting rejected claims
•R
ecognizing revealing data in key performance
indicators (KPIs)
Netsmart’s Plexus Revenue Cycle
Management (RCM) team can turn these
challenges into opportunities for success.
The Plexus RCM team has more than 500 years of collective
experience in healthcare billing, and a record of success
increasing billing efficiencies because of their knowledge
and familiarity with healthcare billing software best
practices. These professionals can take the tedious work of
checking and re-checking, submitting and re-submitting
claims out of your organization and into our Netsmart
service system for streamlined success.
Our RCM services enhance coordination and
communication; ensure coordination across the
organization, from the front office to clinical decisions to
billing and collections; and optimize the billing process
from encounter to claim, turning what could be an everrocky financial ride into a more efficient journey.
Plexus RCM Improves Financial
Performance
To compete in today’s healthcare environment,
organizations need to make sure their financial
operations are running efficiently. The Plexus RCM team
helps providers enhance organizational profitability,
improve financial outcomes and expand client
satisfaction by reducing the time providers spend on
numbers and increasing their ability to focus on what
they do best – caring for their clients.
Netsmart’s Plexus RCM team utilizes an organization’s
existing electronic medical record (EHR) or financial system
to manage the entire life cycle of a claim. The team also
handles eligibility verification, credentialing and provides a
self-pay/call center.
Centralization
The RCM team reduces the amount of provider staff time
needed to manage claims by centralizing it at Netsmart,
where a dedicated team focuses on your financial needs.
The team will organize client billing for you and scan
and scrub claims for errors (such as incorrect ID number)
before they are submitted.
Assurance
The Netsmart team is trained and retrained so it
can continue to address new and evolving payer
requirements as they arise. Issues like new payment
methodologies and ICD-10 represent immense
challenges for claims processing. Our team meets these
challenges head-on, reducing denials.
However, if a claim is denied, the team will help
figure out why – something which can eat up a lot of
manpower at your organization. The Netsmart Plexus
RCM team streamlines this process and then takes note,
fixes it and works to ensure the same mistake doesn’t
happen a second time.
According to a report by the Centers for Medicare &
Medicaid Services (CMS), 40 percent of claims that are
denied on the first submission are never resubmitted,
resulting in as much as a 10 percent loss in profits for
a healthcare organization. Plexus RCM puts that lost
revenue back into your organization.
Best Practices
Netsmart’s Plexus RCM team gives you access to the best
billing practices and protocols of other organizations
like your own. The Plexus team documents these best
practices and leverages them across their suite of clients,
providing a “playbook” of billing policies and procedures
that organizations can reference to improve their own
processes – leading to healthcare billing standardization
and taking variance out of the equation.
Trendsetting
Organizations are often too busy just handling dayto-day requirements that they don’t take the time to
gather and act on revealing data from key performance
indicators. Benchmarking your data against other similar
organizations (or even against yourself between quarters
and years) will help you to see red flags and ensure you
trend for success.
Netsmart’s Plexus RCM team keeps track of days in
accounts receivable, cost to collect, net collections,
denial rates, bad debts and first-pass clean claim rates. It
continuously examines these metrics and will help you
identify and manage trends to ensure strong performance
and initiative improvements, as needed.
The results are stunning:
Get Started with Plexus RCM
The first step toward getting started is going through
a people, processes and technology assessment with
Netsmart Plexus RCM professionals. The team will evaluate
current billing practices and determine opportunities
for improvements through RCM. This strategic planning
process, done in close cooperation with your existing
billing team, identifies priorities and next steps, as well as
an estimate of financial improvements.
Do you want to improve your organization’s
financial performance by increasing billable
services, accelerating cash recovery, reducing
the cost to collect and improving cash flow?
Visit www.NTST.com/PlexusRCM
PLEXUS
REVENUE CYCLE
MANAGEMENT
ADDS UP TO
SUCCESS
PROCESS
PERCENTAGE IMPROVEMENT
Percent of co-pays collected
at time of service
18%
Percent of cash posted to
net charges/billed
40%
Percent of billed accounts
receivable > 90 days
14.6%
Total gross days
revenue outstanding
32%
*For an average client; over a six-month period
*