Revenue Cycle / Practice Management

Managing revenue cycle processes and practice workflows continue to be two of the more challenging areas in healthcare transformation today. Ever-changing regulatory requirements for coding, billing, and compliance mean that the systems put in place even just a couple of years ago may be out of date and need improvement.

Summit Strategic Solutions has extensive experience in all aspects of revenue cycle management and practice operations. Over the past 20 years, we have developed revenue cycle and practice management systems, workflows, and infrastructure, which have transformed over 50 provider practices. We’ve led in the transformation from fee-for-service to value-based care, successfully converted practices to ICD-10, attested to meaningful use requirements for 100% of our client’s full-time providers, implemented automated patient engagement services, and driven revenue cycle collection and payments to best-in-class performance nationally.

As detailed below, Summit Strategic Solutions can optimize the clinical and operational performance of your group overall, while adapting to unique circumstances within your individual practices and to changes in federal regulatory mandates and insurance payment models.

Revenue Cycle Management

Summit Strategic Solutions has generated superior performance for its client practices in the critical area of revenue cycle management. Through refined workflows, well-defined data collection and processing, and sophisticated analytics, Summit Strategic Solutions monitors every step of the claims process and identifies trends in processing and productivity to maximize practice group revenues.

We take a comprehensive approach to automating the revenue cycle process. It begins with using best-in-breed practice management systems, set up and optimized to the specific practice group requirements (patient demographic mix, carrier contracts, provider tracking and reporting requirements, and more). With the practice management system set up and configured, we then implement a multi-pronged revenue collection workflow, which ensures carrier contracts are accurately and fully billed to, and patient and carrier collections are tracked, posted, and reported on for full financial transparency. Our expertise in fee-for-service collections can be leveraged to help you have a clean claims submissions data set. We can also help you with your patient engagement and collections through best practices in help desk design and outsourcing.

Key Revenue Cycle Services we offer include:

Service Area Service Elements / Workflow Steps
AR Revenue Cycle Assessment Summit Strategic Solutions healthcare accounts receivable experts will provide you with a comprehensive current AR Revenue Cycle situational posture assessment, highlighting key opportunities for increasing collections, improving bill/charge submission quality, reducing denials, and for lowering your risks of contractual and regulatory noncompliance. You can fully implement the recommendations contained in the assessment by engaging Summit Strategic Solutions for the AR Revenue Cycle Optimization Program.
AR Revenue Cycle Optimization Program Working directly with your existing AR team (shared service) or fully outsourcing your AR workflows (full service), Summit Strategic Solutions’ service will define and implement the road map of steps needed to fully optimize your revenue cycle. We will work hand-in-hand with your AR IT System vendors, your executive administration, finance department, and executive providers to ensure we tailor your revenue cycle workflows and audit checkpoints to most closely match your healthcare enterprise needs.

Let Summit Strategic Solutions tailor your revenue cycle workflow to meet your administration and executive provider business requirements.

For further information about Summit Strategic Solutions’ Revenue Cycle Management offerings, call us toll free at 866-777-4975 or email us at sales@summitstrategicsolutions.com.

Practice Operations

Summit Strategic Solutions’ seasoned management team has consistently been on the leading edge of clinical and practice operations services. We have led the region as one of the first to market with patient-centered medical home (PCMH), an Accountable Care Organization (ACO), and with value-based reimbursement agreements with governmental and commercial health plans.

Managing a large number of practice locations and hundreds of employees over a broad geographic region also has required advanced organizational expertise. In addition to human resource management, information system management, marketing support, and outpatient specialty services such as lab, imaging, sleep services, physical therapy, clinical research, retail clinic, and inpatient care, we also offer consultation services for financial management, strategic planning, network development and mergers and acquisitions.

Summit Strategic Solutions has helped to establish practice-owned ancillary services, including a central lab that performs 5.9 million tests per year, imaging centers that perform over 75,000 studies per year, a sleep center that performs more than 2,000 studies per year, and physical therapy services in seven practice locations.

Key Practice Operations Services we offer include:

Service Area Service Elements / Workflow Steps
Enterprise Practice Operations Assessment Summit Strategic Solutions healthcare practice operations experts will provide you with a comprehensive enterprise-wide situational posture assessment, highlighting key opportunities for increasing your business opportunities for achieving the quadruple aim, while achieving higher potential levels of profitability and growth.

For further information about Summit Strategic Solutions’ Practice Operations offerings, call us toll free at 866-777-4975 or email us at sales@summitstrategicsolutions.com.

Managed Care Contracting

Summit Strategic Solutions can help your practice group achieve improved financial performance through better contracts with payors. We understand what makes sense contractually from the provider’s perspective, and our systems and workflows can help you achieve measurable financial results.

Over the years, Summit Strategic Solutions has achieved significantly higher client reimbursement rates compared to national and regional norms. We use a focused and disciplined negotiation strategy that will take advantage of client negotiating leverage identified through contract negotiation preplanning conducted with the client’s administrative and provider executive teams. We will take the lead in negotiations, or work closely with you to obtain the best possible contractual terms and conditions.

For further information about Summit Strategic Solutions’ Managed Care Contracting offerings, call us toll free at 866-777-4975 or email us at sales@summitstrategicsolutions.com.

Credentialing Services

Summit Strategic Solutions knows how important credentialing new and existing providers can be to the financial success of your practice group. Summit Strategic Solutions has experienced credentialing coordinators who can provide the experience and expertise needed to create your own internal capability, or to provide a full featured credentialing service.

We will ensure timely enrollment and re-credentialing with all payors and licensing agencies. Included are maintenance and tracking of state licenses, Drug Enforcement Administration (DEA) certifications, continuing education requirements, and specialty board certifications. Medical staff applications and integration with hospital credentialing and privileging processes are provided for inpatient physicians and advanced practitioners.

Thoughout the entire credentialing process, we leverage from industry standard software to track and verify all processes.

For further information about Summit Strategic Solutions’ Credentialing Services, call us toll free at 866-777-4975 or email us at sales@summitstrategicsolutions.com.

Compliance Services

Summit Strategic Solutions offers a range of compliance services, including claims analysis and verification, Protected Health Information (PHI) privacy and security compliance, and Advanced Practitioner (AP) supervision compliance programs.

Our claims analysis and verification programs, which can be provided through consultation or a full outsourced service, will ensure your coding and documentation meet federal and payor contractual requirements. Our workflow includes a proprietary risk scoring system that will help drive needed training and remediation activities. Services include auditing samples of all services provided and billed to Medicare, and internal medical record audits performed by certified physician coders with specialized certifications in E&M auditing.

Our PHI privacy and security compliance programs include the monitoring of state and federal regulations, defining of policies and organizational requirements for fulfillment of regulations, and auditing and responding to HIPAA and other breaches.

AP/Physician Supervision Programs monitor state and federal regulations, define policies and organizational requirements for AP assignment to, and review of clinical notes by an Eligible Provider. We support controlled substance sign-off tracking and will audit and review workflows for compliance.

Key Revenue Cycle Services we offer include:

Service Area Service Elements / Workflow Steps
Claims Compliance Assessment Whether you seek to refine an existing claims compliance workflow, or create a new workflow based on your current practice needs, Summit Strategic Solutions’ Claims Compliance Assessment can help you mitigate business risk and liability. Our workflow includes a comprehensive clinical documentation review to assess level of support for the claims process. Our workflows are based on historical knowledge of E&M code usages, distribution, and mix.
Privacy and Security Compliance Assessment Our team of HIPAA and security compliance experts can help your enterprise ensure compliance with all aspects of HIPAA rules and regulations. Our workflows will include an assessment of IT systems and personnel training requirements to ensure compliance of systems that record and maintain PHI.
AP / Physician Supervision Programs Summit Strategic Solutions can help you establish processes or outsource for you the regulation monitoring, policy development, and organizational requirements for managing AP provider resources. We will help you understand state-specific requirements related to clinical note review by an EP, controlled substance sign-off tracking, and audit and review of workflows for compliance.

For further information about Summit Strategic Solutions’ Compliance Services, call us toll free at 866-777-4975 or email us at sales@summitstrategicsolutions.com.

Clinical Quality Programs

Summit Strategic Solutions provides a comprehensive range of services targeted at improving patient quality of care. Translating quality into practice operations requires multiple initiatives, each of which Summit Strategic Solutions can help implement. We can support the identification, implementation, and behavior changes needed to drive standards-based care. Further, data related to patient functional status and well-being, tied with data about clinical outcomes can be collected, analyzed, and disseminated as needed. Our experience in driving clinical quality programs into the organization and managing the change process needed for successful implementation can be leveraged by your healthcare enterprise as well.

Summit Strategic Solutions can help you implement quality programs in any of the following areas:

  • NCQA’s Patient-Centered Medical Home (PCMH)
  • Diabetes Recognition Program (DRP)
    Heart/Stroke Recognition Program (HSRP)
  • Patient quality reporting system (PQRS)
  • Utilization management
  • Narcotic prescription auditing
  • National quality forum for Medicare Shared Savings Program
  • National Center for Quality Accreditation (NCQA)

Summit Strategic Solutions offers clinical quality program services customizable to your specific needs. We can provide consulting services to help you identify and prioritize which programs to pursue and provide guidance on best practices needed for success. We can also help refine your existing programs by providing staff augmentation and consultation services to help you get the most out of your existing staff and workflows.

For further information about Summit Strategic Solutions’ Clinical Quality Programs, call us toll free at 866-777-4975 or email us at sales@summitstrategicsolutions.com.

Human Resources Management

Summit Strategic Solutions offers a complete range of human resources and talent acquisition services to meet the unique requirements of practice and healthcare groups. We will meet directly with your healthcare enterprise administrative and provider management to understand overarching organizational goals related to organizational development, compensation strategy, employee benefits, recruitment, and employee and customer engagement programs. Based on your organizational requirements, we can offer one or more of our standard Human Resources Management Service packages, or custom craft a solution mix to meet your particular needs.

Typical Human Resources Management Services we offer include:

Service Area Service Elements / Workflow Steps
Benefits Administration Summit Strategic Solutions offers consulting and management services to help your organization negotiate annual group health and welfare (exclusive of 401(k)) plan rates as well as evaluate a benefits diversification/offering strategy. We will ensure your organization meets legal requirements for compliance with the Employee Retirement Income Security Act (ERISA) (e.g., administering life events throughout the plan year), including preparing all plan documents and legally required federal notices. We also offer services related to annual enrollment education and process completion, COBRA/Retiree Health Plan Administration, and managing Carrier File Feeds (e.g., sending weekly electronic enrollment data).
Physician and Advanced Practitioner (AP) Recruiting Summit Strategic Solutions Physician and Advanced Practitioner (AP) Recruiting Services provide the full range of capabilities to support your recruitment from position approval and posting to fulfillment and credentialing. Using your existing human resources IT system, or a new one we help recommend, we will electronically manage all open requisitions, source and track physician/AP candidates, and align candidates with appropriate hiring managers. Summit Strategic Solutions will optimize your provider hiring process, from contract to credentialing to orientation to on-boarding. With Summit Strategic Solutions, you can rest assured that your organization will have a smooth hiring and on-boarding process for your valuable new providers.
Employee Services Summit Strategic Solutions offers a broad range of employee on-boarding and retention services and programs. These can be offered on a consultative basis, or offered to your organization as a completely staffed full-service offering. Typical Employee Services include:

  • Family and Medical Leave Act (FMLA) Administration
  • Workers’ Compensation Administration
  • Employee Wellness Plan Administration
  • Human Resources IT Administration/Data Mining
  • Employee On-Boarding/New Hire Orientation
  • Performance reviews
Consulting Programs If your healthcare enterprise is looking for a more strategic assessment and road map plan for its talent development and retention, Summit Strategic Solutions offers a broad range of customizable consulting services to help you achieve your organizational goals. Programs and services we offer include:

  • Organizational Goal Alignment Program
  • Leadership Development Plans/Programs
  • Compensation Strategy Development Plans/Programs
  • HR Compliance Assessment and Development Plans/Programs
  • Corporate Responsibility
  • Ethics Development and Improvement Plans/Programs
  • Mentorship Programs

For further information about Summit Strategic Solutions’ Human Resources Management offerings, call us toll free at 866-777-4975 or email us at sales@summitstrategicsolutions.com.