Integrated information and process management platform enables a holistic, centralized approach to clinical documentation to overcome revenue cycle inefficiencies.
TAMPA, Fla., May 3, 2022 /PRNewswire/ — Toney HealthCare Consulting (THCC) is launching Utilization Management 360® (UM360), a clinical revenue cycle management platform that helps healthcare providers harness patient care information holistically to make the billing process more efficient while improving the quality and safety of patient care. The platform is a provider-oriented case review technology infused with a payer’s perspective, leveraging THCC’s extensive experience with managed care organizations. This balance helps to support value-based contracting and pay for performance arrangements. UM360 highlights incomplete and inconsistent documentation elements across the functions of clinical Revenue Cycle Management.
Without UM360, information on patient care can exist in different documentation systems with little information sharing. Inaccurate and incomplete documentation due to fragmented revenue cycle processes leads to inadequately justified requests for payment by healthcare providers, insufficient reimbursement to healthcare providers, and inefficiencies for payers and providers in the payment process. Incomplete documentation may also reflect gaps in the provision of care and care quality.
UM360 takes a holistic, centralized approach to clinical documentation and highlights incomplete and inconsistent documentation elements across the five key functions of Clinical Revenue Cycle Management: Utilization Review, Case Management, Clinical Documentation Integrity, Physician Advisor and Coding/Compliance. The platform helps care providers:
- Promote patient safety and quality of care by clarifying medical necessity and pointing out care gaps
- Justify services provided and billed to support appropriate payment and avoid denial or reduction of payment
- Aid in regulatory compliance by demonstrating processes are understood and consistently executed
- Share knowledge across clinical revenue cycle functional areas to provide the full picture of care and streamline operations
"Siloed revenue cycle functions proliferate the healthcare landscape resulting in miscommunication and inefficiencies across clinical, care quality, operational and financial dimensions," said Sam Toney, M.D., CEO of Toney HealthCare. "We are pleased to bring to the industry a meaningful solution that brings together payer and provider perspectives to harness the value of information holistically. UM360 is a first-of-its-kind platform that helps healthcare providers, patients and health insurers by promoting good documentation of care."
UM360 is a web-based or on-premise platform that can be rapidly customized and deployed to hospitals and healthcare systems, and is available now. THCC also provides training, support and advisory services to optimize the function of the system.
About Toney HealthCare Consulting
Headquartered in Tampa, Florida, Toney HealthCare Consulting (THCC) provides advisory services, hands-on leadership, enabling technologies and experts in clinical operations, quality, regulatory and compliance, and accreditation for healthcare organizations nationwide. Our team consists of over 350 subject matter experts, clinicians and administrative professionals with deep healthcare and managed care strategic and operational expertise. THCC has been a trusted advisor delivering customized solutions to clients since its founding in 2008. For more information, visit www.toneyhealthcare.com.
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SOURCE Toney HealthCare Consulting