Strategy and Consulting
Strategy and Consulting
Change is a constant in business, and how an organization responds to it defines its success. Vertex Medical Billing empowers healthcare organizations to achieve exceptional results by combining deep industry expertise with advanced processes. We develop and implement customized strategies designed to adapt, evolve, and deliver lasting impact.
At Vertex Medical Billing, our domain experts are dedicated to delivering solutions that enhance efficiency, uncover growth opportunities, introduce innovative technologies, mitigate potential risks, and ultimately save both time and costs.
We help organizations navigate and adapt to change with confidence. By streamlining operations and crafting effective strategies, we transform challenges into actionable results—driving measurable success and empowering your organization to thrive in a competitive healthcare landscape.
Revenue Cycle Consulting/Revenue Recovery
The healthcare landscape is in constant evolution. Mergers and acquisitions are on the rise, regulatory shifts are reshaping organizational operations, reimbursement rates are tightening, and the transition to value-based care is more prominent than ever. At the same time, emerging technologies are unlocking opportunities once thought unattainable. We offer a wide range of healthcare and business consulting services tailored to help organizations optimize operations and drive growth. Our expertise includes providing thorough merger and acquisition due diligence to support informed decision-making, as well as comprehensive revenue cycle management consulting and full revenue cycle audits to enhance financial performance. We conduct detailed coding audits and managed care contracting reviews to ensure compliance and maximize revenue opportunities. Our services extend to risk adjustment strategies, leveraging business intelligence and data analytics for deeper insights. Additionally, we incorporate advanced technologies such as Robotic Process Automation (RPA) and Artificial Intelligence (AI) to streamline processes, alongside applying Lean and Six Sigma best practices to drive continuous improvement and operational efficiency.
Care Coordination and Chronic Care Management
Effectively managing chronic conditions or serious injuries demands active collaboration between patients and providers. Vertex Medical Billing’s care coordination specialists assist healthcare providers in identifying areas for improvement, helping them guide patients seamlessly through the healthcare system.
Inpatient (Hospital and Physician)
Vertex Medical Billing’s skilled CDI assessment specialists carefully review provider documentation to ensure a precise reflection of each patient’s clinical condition. Inconsistent, incomplete, or vague medical records not only impact patient care but can also result in significant revenue loss.
Provider Network Data Management
Vertex Medical Billing is dedicated to enhancing Case Mix Index (CMI) and DRG-based revenue, driving improved cash flow and increased revenue for our hospital and health system clients.
Provider Education
When it comes to provider education, its interpretation often varies depending on the audience. For some, provider education specifically refers to training and guidance tailored for physicians, practitioners, therapists, and other clinical care professionals.
E/M Auditing & Consulting
CMS audits have shown that nearly 42% of claims containing evaluation and management codes are incorrectly billed each year. With ongoing regulatory updates and industry changes, this percentage is expected to rise significantly.