Transitioning from outsourced billing program to in-house centralized billing program

The Journey Begins

Revenue cycle management and financial outcomes are intrinsically linked to the efficient exchange of information between clinical, operational, and financial systems. A well-defined process for sharing this information, starting from pre-registration to admission, treatment, discharge, and finally billing, leads to the most successful results. A typical revenue cycle strategy for long-term care providers relies on the seamless flow of clinical data directly to billing and collections.

The Challenge: Outsourced Billing Program

Transitioning from an outsourced billing process to an in-house, centralized billing program is a monumental task. It requires multi-level planning across all disciplines and management structures within a multi-site organization. These changes in billing requirements and healthcare environments led a California-based provider to review their billing systems and explore opportunities for increased efficiency and regulatory compliance across their five campuses.

ProviNET’s initial Discovery process revealed procedures that did not support the changing regulations and the ongoing need to ensure accurate claims that reflect the clinical information needed to support the services reflected on the claims. The provider was outsourcing their billing, and staff was required to bridge the gap between the clinical information and the billing information. ProviNET immediately realized the need for efficient and comprehensive systems to ensure compliance with regulations and to improve the revenue cycle.

The Planning Phase

ProviNET Solutions was asked to work with the organization to consolidate the billing process and assist with the development of clinical systems to improve compliance and accuracy across all disciplines. After initial planning, ProviNET’s consultants conducted an online evaluation of a select number of Minimum Data Sets (MDSs) to assess the types and amounts of services being provided. This also enabled us to assess the quality and completeness of the MDS sample.

ProviNET continued with a review of claims as the next step in the initial analysis process. Schedules were then set up at each facility to conduct on-site documentation reviews and staff interviews. On-site reviews provided the opportunity to look at community-level procedures and to appraise the documentation practices that ultimately drive and support billing.

The Implementation

ProviNET was successful in assisting its customer through the process of bringing their billing in house, which led to more timely and accurate claims as well as a greater appreciation between the many clinical and operational staff and the finance team. The project led to the ability of the IT staff at the organization to establish an ongoing implementation of the electronic medical record. ProviNET assisted in the introduction of Touch Screens, Clinical Notes, and other electronic advancements.


Our goal is to deliver quality and cost-effective solutions, enabling you to dedicate your resources to providing excellent care and services. To learn more about transitioning from an outsourced billing program to an in-house centralized program, contact a ProviNET professional today.

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