Category Archives: Financial Management Services

Nearterm, a managed services provider, shares articles, news & commentary on relevant issues in the Healthcare Financial Management services arena.

A Look at Nearterm’s RCM Consulting Nationwide

Revenue Cycle Management Consulting Projects Nationwide

Most likely Nearterm has done an RMC Consulting Project in your state.  Find out with our Interactive Project Map.

Nearterm provides client-centered revenue cycle and financial management consulting services to hospitals, physicians and other healthcare providers nationwide. Our hospital revenue cycle management services see and deal with the full spectrum of revenue cycle issues that the healthcare industry faces today, on a national as well as on a state-by-state basis.

You may or may not know what kind of Revenue Cycle help you need. Either way, we can help you with enhanced financial performance through:

  • Increased cash flow
  • Lower bad debt expense
  • Improved customer service
  • Reduced operating cost
  • Increased productivity
  • Backlog elimination
  • Cash acceleration
  • Reorganization

Here is Brief Look at how our RCM Consulting Process Can Work for You Anywhere in the U.S.

Situation Analysis

As the basis for planning and decision making, we perform discovery, research, analysis, objective operations assessment and strategy determination in close collaboration with you.

Operations Action Plans

Based on the results from the Situation Analysis, we develop a Plan of Action (POA) process. The POA is a proprietary service that will lead your organization through a very structured process aimed at establishing targeted change.

The plan is always to provide clients with creative and practical solutions to the problems and issues they face.

Implementation Assistance

If you need it, we can deliver the additional “horsepower” and any type of experienced resources for implementing certain planned activities. These resources can work from remote locations and/or onsite, whatever you and the POA requires of them. Whether in Finance, Revenue Cycle, Patient Access, Patient Accounting, HIM or related disciplines, we can deliver top notch talent;

  • Leadership (VP, Director, Manager, Supervisor, Team Leader)
  • Technicians (AR Specialists, Coders)

Other Services Related to RCM

In conjunction with the RCM services described above, we also can:

  • Develop and document policies and procedures
  • Present customized training programs
  • Design reporting packages
  • Provide conversion assistance
  • Assist with a variety of other offerings to meet your organization’s specific needs.

While our vision has remained constant, our services have evolved progressively to meet and sometimes shape the evolving environment facing healthcare revenue cycle leaders today.

We will treat your business like our own and measure success based on your satisfaction.

Ask the RCM Experts


Posted By: nearterm-admin

What are the “Pros & Cons” of Centralized Revenue Cycle Processing, You Ask?

Jim Matthews RCM & Healthcare Financial Management Consultant
Jim Matthews, Principal, Nearterm Corporation

Hospitals and other healthcare provider organizations that have become multi-facility entities often consider centralizing RC Processing and/or AR processing. The strategy is usually aimed at lowering operating cost, improving financial management performance and better customer service.

As a Revenue Cycle Management (RCM) consulting company, Nearterm has a lot of experience assisting clients with centralization (and decentralization) initiatives and so we could write volumes on this topic, but in lieu of that, this article offers a just few “bite sized” observations that you might find interesting.

Homogeneous vs Heterogeneous Transaction Volumes

Banking, financial services, retail industries and others have been very successful with centralized billing, payroll, collection processing. If they can do it, we can do it, right? Not so fast. Every transaction processed through their clearing houses looks the same.

A VISA charge transaction is the same (or alike) in every state and for that matter, all over the world – these are homogeneous transaction volumes. However, when two or more hospitals having different operating systems, contracts, policies and patient types consolidate, the volumes are different – they are heterogeneous.

There are technical solutions for both types of transaction volumes, but cost, lead time and maintenance of these conduits can be material to the centralization decision. If the organization does not achieve homogeneous volumes in the proposed processing environment, arguably, it has just combined things under the same roof, still functioning as before and with little or no gain of efficiency.

Benefits of Centralization

There are two critical areas where centralization of hospital revenue cycle processing offers benefits; Revenue Cycle Management (RCM) and Health Information Management (HIM) technology.

Both RCM and HIM consolidation yields budget savings that can be applied to improving compensation offerings available to build new RCM and HIM teams. You can attract stronger talent that will enable you to benefit further from their expertise across the newly centralized operation.

Impact on Internal Business Relationships & Communication

Relationship challenges are often underestimated. We are referring to the multiple relationship and accountability changes that occur when for example a hospital moves billing and collections to a centralized business office (CBO).

Ask yourself:

  • Who is responsible for AR performance?
  • If the hospital is allocated CBO expense, does it have control over CBO budget?
  • How are data collection and data entry problems that begin at patient access handled to the extent that they impact CBO performance?

Indeed, there are many more questions to resolve well ahead of the decision to centralize. Our RCM Consultants and Strategists recommend report design that clearly delineates accountabilities between entities and detailed policy statements about accountability. Drafting these and using them as compatibility “tests” prior to the decision may reveal crucial development opportunities that if addressed, promote a harmonious and successful transition.


Centralization and consolidation of revenue cycle processing can be a very effective way to meet the challenges facing provider organizations in these changing times. Many have done it successfully.

We also know that many “centralized” organizations would like to “decentralize” and would say they should never have done it in the first place. Here, the key is to have consensus about expectations, timeline and accountability, as a critical piece of the decision process, and not part of the implementation process when it would threaten the success of the transition.

The above are intended as a broad overview. Nearterm Revenue Cycle Consultants and Strategists are always ready to work with you in considering the pros and cons of centralization or decentralization, and any other Revenue Cycle initiatives under consideration.

Jim Matthews
Principal, Nearterm Corporation

Follow Jim on LinkedIn 

Ask the RCM Experts

Posted By: nearterm-admin

Too Busy to Look at Patient Accounts, You Say?


Jim Matthews RCM & Healthcare Financial Management Consultant
Jim Matthews, Principal, Nearterm Corporation

Early in my Revenue Cycle Management (RCM) career before I went into RCM consulting, I was an RCM Executive with a hospital chain and had responsibility for 14 hospitals.

I actually thought that I was too busy to look at patient accounts. After all, there was a hospital budget to prepare, a seemingly unending stream of meetings to attend, performance appraisals to complete, accounts receivable reports to produce and review, a system conversion right around the corner and a myriad of other priorities.

Then one day I was asked, “What is the work product of the revenue cycle organization that you manage?” That’s an easy answer, so I thought…it is 3 things – cash, patient satisfaction and cost effectiveness. Then came a lightning bolt that revealed that those 3 things are certainly RCM objectives, but they might not be the work product.

I asked myself what I could do to ascertain that the revenue cycle team was doing the things every single day that help us achieve our RCM objectives. Conclusion; look at patient accounts and think of that as a review of our work product and include that as part of my management practice.

The protocol I established for myself was more than a look at random accounts. Reports were designed that queued a specific stratification of patient type, payor, balance range, age and alpha split at intervals that would provide me with statistically meaningful samples.

I scheduled 3 consecutive hours each week to shut my door and review the designated accounts. The review was a discovery process so I looked at almost everything in each account history. When problems and/or questions came up, I would either call whomever in my organization was responsible, even by-passing their managers. I asked them to pull up the account and reviewed it with them or else posted a note to the account requiring a response. I was in a leadership position and had a lot of employees in several facilities reporting to me so these calls and notes came as a surprise to many until word was out that I had embraced this practice.

If I had to single out a management practice that effectively helped us improve revenue cycle performance and accountability, review of work product would be it. It answers the question, “Are we methodically doing all we can every day to reduce outstanding receivables and increase collections?”

A number of positive things happened relatively quickly when this work product protocol was implemented. Here are a few examples;

  • Is What was “Done,” Really DONE? We learned that many of the things we thought we were doing were not really being done consistently or in some cases not at all. By surfacing these items, we could address them. You can’t fix what you don’t know about.
  • If it is Not Documented, it was NOT DONE! It became apparent throughout the revenue cycle organization that account documentation was of critical importance. When I would call an AR technician to ask why no work was documented on an account, the response was often that the work was done, just not documented. We had a teaching moment to reiterate, “If it is not documented, it was not done”.
  • Work Product Improvement Soon Becomes a Team Effort. The entire organization, not just the management team, became engaged in problem solving. When account history patterns surfaced, the people doing the work typically had the right solutions but had not been asked for their ideas before.
  • Managers MUST be Involved. Managers who reported to me were out of touch with the work product of their employees. When I personally began to get involved at the detail level, they quickly realized they had better do the same. When I identified a problem by talking with one of their staff, I would then contact the manager to discuss the problem and how we might solve it. It was not long until they too began account reviews similar to the ones I was doing so that they could identify and bring opportunities to me rather than their folks telling me. They were a very good team when we started and were even better as a result of this practice.
  • Lead By Example. I had always talked and written internally about what was important in our organization. However, I don’t think people embraced my guidance about what was important until they saw that I was investing my time focusing on lag times, wait times, quality of calls, frequency of contacts and other things I could see by looking at a patient account. I have always believed that people decide what is important based on how we as leaders spend our time, not what we say or write in memos.
  • Enjoy a New Found Team Spirit. The whole process was not only revealing and educational, but it was also fun! I got to know the people doing the work a lot better and enjoyed the collegial approach that grew from the process. I got a lot closer to the people in my shop.

So lesson learned. Success lies in the details of patient accounts.

Now as a revenue cycle and financial management consultant and strategist, I stress to senior managers how very important it is to be attuned to the details of their operation, especially the work product. No matter how “busy,” patient account managers must have a process in place to review the quality of their work product and the discipline to know what is happening with the team in their offices.

Jim Matthews
Principal, Nearterm Corporation

Follow Jim on LinkedIn 

Ask the RCM Experts

Posted By: nearterm-admin

5 Big Hospital CFO Concerns for 2015

5 Big Hospital CFO Concerns for 2015Are These Still the 5 Big Hospital CFO Concerns for 2015?

According to an article by Rene Letourneau, for HealthLeaders Media, December 1, 2014, where he interviewed a number of CFOs, there are 5 Big Hospital CFO Concerns for 2015. Now almost in the middle of 2015, do you agree with his prognostications?

  1. Declining Utilization

As hospitals move towards a value-based system, the quality of care improves and so too, do patient outcomes. With that success comes reduced patient volume (and revenue) as inpatient care declines. All that can have a negative impact on the hospital revenue cycle.

Medicaid expansion offers only short term help as more patients coming from the previously uninsured low-income population. “Bigger forces will continue to drive down utilization.”

Better ways of delivering care must be found that do not impact the revenue stream or the quality of care in a negative way. Balance has to be found.

  1. High Deductible Health Plans

As patients are now faced with higher deductibles, it is expected that collections in 2015 will increase unless CFOs “rethink internal processes in order to protect revenue.”

Through outreach and early and frequent patient engagement, CFOs are considering moving the revenue cycle process upfront to forestall collection issues at the back end. Solutions considered include educating patients about their financial obligation early and offering options to facilitate payment either through upfront payment or financial assistance.

  1. Downgraded Credit Ratings

“As we move away from fee-for-service reimbursements, the investments we have to make are not capital investments. They are operating investments that cannot be capitalized or amortized.”

Equipment and facilities can be capitalized but “integrating our physicians and becoming a clinically integrated network” cannot be capitalized.

  1. Medicaid Expansion Woes

“Many health systems in states that are not expanding Medicaid are facing real financial peril due to significant cuts to the Disproportionate Share Hospital program, which makes federal payments to qualifying hospitals that serve a large number of Medicaid and uninsured individuals.”

Even for hospitals in states that have expanded Medicaid there is risk. “As we all know, when the economy takes a downturn, one of the first places states look to cut is Medicaid so having more Medicaid beneficiaries means having more risk.”

  1. Making EHRs Pay Off with Actionable Action

“Once an EHR is up and running, the key to maximizing it from the financial perspective is to extract and analyze the data in a way that leads to standardization of care and a reduction in the use and duplication of expensive clinical resources.”

Read the entire article written by Rene Letourneau, for HealthLeaders Media , December 1, 2014.

Posted By: Nearterm Houston
Managed RCM