MURFREESBORO, TN – The state of today’s economy is forcing healthcare providers to take a closer look at revenue cycle management – and many companies to refine their RCM offerings.

The latest to bolster its portfolio is ClaimTrust, a Murfreesboro, Tenn.-based developer of RCM tools for hospitals. The company, founded in 1998, launched its InSight Revenue Cycle Solution on Tuesday, looking to transform its claims scrubbing product to an end-to-end RCM tool.

“We have to take the entire continuum of the revenue cycle into consideration in order to be effective,” said Joe Ferro, the company’s president and CEO. That includes registration, scheduling and order-entry, he said.
Working with the company’s Workflow and Claim Editor platform, the new solution operates in conjunction with hospitals and payers. Tools include a medical necessity database, which reviews and compares diagnosis and procedure codes with a payer’s medical necessity rules to avoid denials, a claims scrubber, a variance analyzer and a denials tracker.

According to Ferro, ClaimTrust will add new tools this fall, including a RAC module to handle the Centers for Medicare and Medicaid Services’ Recovery Audit Contractor program and a payment variance analyzer, which will calculate reimbursement on every claim edited at the time of billing.

Ferro said hospitals are struggling to keep up with the complex world of revenue cycle management, where each payer has its own codes and rules. “We have to translate all that information put it in a format that is easily understood,” he said. “We can get the claims out the door quicker and with more accuracy and efficiency, which results in new net revenue.”

According to a white paper prepared by Karen Bowden, the company’s president of consulting, hospitals generally don’t go after that final 5 percent of revenue in the collections process because it costs more to pursue the claims than they’re worth. With the average clean claims rate for hospitals at 75 percent to 85 percent, and 15 percent of a hospital’s total costs spent on the payment process, that’s a lot of money left on the table.

“The good news is that today, best practices, analytics and revenue-cycle technologies have reached the point where hospitals can achieve substantial revenue improvements for relatively small investments in time, technologies or services,” Bowden wrote.  “The cost to collect, especially from payer organizations, can be reduced to the point that near 100 percent collection has now become an attainable and sustainable goal.”