Navigating Budget Constraints: Revenue Optimization Strategies
By: Amy Morrow, Managing Consultant, Revenue Cycle Expert, and Shelly Noyes, Partner, Delivery & Talent
As hospitals and health systems, particularly those serving Medicaid populations, brace for potential funding reductions, many are reevaluating budgets and exploring how to increase revenue and operate more efficiently without sacrificing care.
At first glance, now may seem like a time to scale back, however investing in the right optimization strategies can do more than safeguard your bottom line; they can strengthen it. Within the MEDITECH platform, targeted improvements can enhance revenue capture, accelerate cash flow, streamline operations, and reduce manual burden. These strategies not only support financial resilience; they also help organizations maintain internal control and reduce reliance on outsourcing during lean periods.
Where to Focus Your Efforts
Below are four high-impact areas where Haffty Consulting is helping clients generate measurable financial improvements through optimizing their MEDITECH systems:
Charge Reconciliation: Capture What You Earn
Are you confident that you are charging for everything you should be? MEDITECH Expanse 2.2 introduced enhancements to Charge Reconciliation that many clients have not yet taken advantage of. If you are not using this feature, you may be missing charge codes and revenue opportunities.
First Step: Work with your analysts or a MEDITECH advisor to configure this tool for your environment. It is a relatively low-effort initiative with a high ROI. If you are not yet on Expanse v2.2, review best practice information on MEDITECH Circle regarding the steps you can take.
Automate Manual Charge Capture
Manual charge entry persists in many departments, and it is a drain on time, accuracy, and revenue. Start by identifying areas where charges are being manually entered and evaluate opportunities to automate capture in the background based on clinical documentation or order sets. Also, review and implement ED care level codes for nursing documentation to ensure accurate care level coding and minimize reliance on staff documentation alone.
First Step: Departments like ED, Surgery, and Infusion often have strong potential for automation using PCS and RCG configuration tools. Start by identifying where manual charge capture exists and review workflows for high impact areas. Reference MEDITECH’s Acuity Build Guide for additional information.
Coding Levels: Align Clinical Documentation for Maximum Reimbursement
Now is the time to review your provider documentation templates for acute, ED, and ambulatory to ensure they emphasize medical decision-making and support appropriate reimbursement levels. For organizations that have not fully implemented the 2023 coding guidelines or have not optimized documentation to support higher coding levels, this can help.
First Step: Even modest improvements in documentation quality can lead to higher coding levels and improved revenue capture without increasing patient volume. Review how coding levels are being assigned, are they being added by the coder vs supported by provider documentation? If documentation does not support higher levels, review your documentation templates next.
Improve Clean Claims and Denial Rates
Clean claims go out faster, get paid faster, and require less costly follow-up. Leverage tools already available in your MEDITECH environment, such as account checks to efficiently and accurately update claims, denials management, and payer contract management. These can significantly improve your cash flow and reduce manual intervention by staff.
Also, consider where your data is stored. Would moving functionality from your clearinghouse to MEDITECH allow you to maintain a single source of truth and operate more efficiently, or should it remain where it is? A few years ago, a large data breach prevented many organizations from sending claims. Organizations that performed claims checks directly in MEDITECH—rather than through their clearinghouse—were able to transition to a new clearinghouse and recover more easily when the need arose.
Setting up Contract Management/Proration in MEDITECH will identify adjustments upfront for more accurate accounts receivable, enabling the use of variance reports to identify reimbursement shortfalls, forecast proposed contract renewals, and auto-adjust late charges when their manual processing would have no impact on reimbursement.
First Step: Set a baseline clean claim rate, HFMA recommends 98% for prompt payments, lower denial rates, and track improvements over time. Even a small percentage increase in first-pass resolution can translate into faster reimbursement and revenue gains.
Final Thoughts: Efficiency Drives Values
Optimization does not have to be expensive. In fact, during budget constraints, optimization is often the clearest strategic move. Configuring existing tools, improving documentation, and capturing missed revenue are all attainable steps that drive financial results.
Haffty Consulting helps hospitals and health systems get more value from their MEDITECH investment by turning inefficiencies into opportunities. Whether you need support evaluating revenue leakage, configuring underused functionality, or improving documentation, our team is ready to help you generate tangible financial outcomes.
Let’s talk about how you can work smarter—and stronger—even in lean times.