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More on Revenue Cycle Management

More vendors are offering their own RCM

A Practice may  be small or large, but its challenges are essentially the same: get patients in the door, establish a clinical record, ensure smooth billing and receive prompt payment. As direct as the process looks on paper, every step has its own pitfalls, and each warrants close attention. To help connect the dots, more and more vendors are offering their own suites of revenue cycle management solutions, whether the task at hand is maximizing reimbursements or removing roadblocks from the billing process. “Billing is always one of the biggest issues” said Brad Lund, executive director of the 700-member Healthcare Billing & Management Association. “Whether you’re an anesthesiologist who averages $2,000 a visit or a pediatrician who averages $80, a similar amount of work goes into it.” Each change to the national health landscape presents its own set of hurdles; Lund cites HIPAA implementation and the continuing push for electronic medical records as just a few examples that make revenue cycle management suites, whatever their brand, an indispensible part of the modern practice. “Today it’s these,” Lund said. “Tomorrow we’ve got to deal with ICD-10 and 5010. We’ve got a big challenge ahead of us.”
 

THREE TRENDS TO WATCH

Brad Lund, executive director of the 700-member  Healthcare Billing and Management Association sees three trends coming up in revenue cycle management:

1. RECOVERY AUDITS: Medicare’s RAC audits are affecting nearly every financial process for healthcare providers. Revenue cycle is no exception. As RAC auditors aim to find irregular claims information, providers need to ensure their systems can appropriately manage and process all financial data.

2. ICD-10: RCM and practice management systems that aren’t preparing for “the onslaught of ICD-10” are going to leave their users facing significant billing issues, Lund said. Solutions that will accommodate the major transition from ICD-9 will rise to the top.

3. EMR PROJECTS: Providers implementing EMRs should be focused on integration with their RCM solution. “The whole EMR thing is on the clinical side. And that’s OK, but we can’t forget the financial relationship between the patient encounter and how you’re moving that information to the payer and how the adjudication is moving back to the provider,” said Lund.

VENDOR SHOWCASE

Alpha II
CodingSystem
A comprehensive, front-end code search and editing software, CodingSystem provides faster, more accurate coding so medical coders can minimize denials, demonstrate medical necessity, ensure compliance and capture more legitimate reimbursement.
Contact: 888.889.6777, info@alphaII.com

ECLIPSYS
Sunrise Patient Financials
Sunrise Patient Financials is a comprehensive revenue cycle management solution that spans the entire revenue cycle process, including scheduling, registration, clinical care and billing processes. By integrating financial and clinical operations, this solution helps healthcare organizations reduce costs associated with unauthorized services and mismanaged resources and improve reimbursement.
Contact: Brad Tinnermon, 404.847.5224, Bradley.Tinnermon@Eclipsys.com

Hyland Software
OnBase
OnBase removes paperwork and unites data throughout the revenue cycle – from registration to final payment – allowing staff to focus on what brings cash in the door faster. More claims are accepted, reimbursements are maximized, cash flow is accelerated and receivable days are decreased for healthcare organizations using OnBase.
Contact: 440.788.5000, healthcare@onbase.com

McKesson Provider Technologies

Horizon Enterprise Revenue Management  
The most recent addition to McKesson’s revenue management portfolio. Its access management module allows healthcare organizations to collect appropriate financial information on patient treatment to help meet regulatory requirements and collect full payment for services at the beginning of the patient interaction process. Supports the creation of charges, distribution of claims and receipt of payments. As an “open” technology, Horizon Enterprise Revenue Management seamlessly connects to both McKesson and non-McKesson clinical technology. These connections make it possible to manage financial processes across all care settings and enables continuous medical necessity checking; coordinated care planning and case management; and collaboration of orders and scheduling. It also enables hospitals to handle emerging revenue management requirements related to pay-for-performance and ICD-10.
Contact: Jeannie Butler, 404.338.3923, jeannie.butler@mckesson.com

MedSynergies
Hospital-Physician Alignment Solutions
MedSynergies leverages its knowledge and experience in hospital/physician alignment to improve processes, optimize technology and build on trusted patient relationships. Its hospital/physician alignment solution helps hospitals and physician practices lower denial rates, accelerate cash flows, increase profits and offer quality healthcare efficiently and cost-effectively.
Contact: Clayton Harbeck, 888.275.9410, info@medsynergies.com  

MPV
Patient Portion Pricer
MPV Patient Portion Pricer enables practices to accurately calculate insurance allowables at or before the time of service so they can determine the patient’s portion of the bill for medical procedures based on applicable deductibles, co-insurance and other patient responsibilities.
Contact: Meredith Wilson, meredith.wilson@mpv.com, 866.930.1230 

NextGen Healthcare Information Systems

NextGen Practice Solutions
NextGen Practice Solutions is a technology-driven, revenue-improvement services group that will help you create an efficient and effective business operation, so you can focus on patients – and get paid faster, too. Services include A/R management, billing/collections, provider enrollment, technology solutions and more – all fully integrated with EHR, a patient portal and ePrescribing.
Contact: Joe Purnell, 404.467.1500, jpurnell@nextgen.com, http://www.nextgen.com/ps/

Select Health Management
Charge Capture Integrity Program
Identifies charges lost during the often complex hospital charge capture process.  Management by exception reporting is written around seven key clinical modules, with the ability to customize the application to meet your specific needs.  Program offers identification, validation, prevention and maintenance, enabling hospitals to stop losing out on revenue they deserve, and facilitates accurate charge capture processes. Validated results are immediate and quantifiable, helps hospitals improve the accuracy, clarity and completeness of their documentation, teaches proper coding and promotes relationships between patient care and inpatient coding teams.
Contact: Jackie Francis, 239.775.7773, jfrancis@shminc.org

ZirMed
ZirMed
Complete revenue cycle solution including eligibility verification, claims management, electronic remittance advice, patient payments, patient collections, and healthcare analytics (denial management and decision support, PQRI solutions).
Contact: Linda Vatter, 502.779.4337, linda.vatter@zirmed.com

Zotec Partners
Electronic Billing Center (EBC)
As a revenue-enhancing product, the EBC is where charges are created, payments are posted, images are scanned, appeal letters are generated and all charge follow-up activity occurs. Specialists interact seamlessly with tax ID numbers, patient profiles and service records and easily address patient needs.
Contact: 317.705.5050, sales@zotec.com
More at HealthcareFinanceNews.com

REVIEWS

“With the use of Horizon Enterprise Revenue Management, Gwinnett has decreased medical record duplications from 8 percent to just .31 percent.  “We went from being very average to being one of the top performers in the country on the medical record duplication metric.”
– Cathy Dougherty, assistant vice president, revenue management, Gwinnett Health System
Lawrenceville, Ga.

“Navicure has enabled us to significantly improve our revenue cycle. In fact, days in AR over 90 has improved by 303 percent and net collections have improved by more than 100 percent.”
– Becky DaMoude, director of physician billing, North Platte Physicians, North Platte, Neb.

“Excel couldn’t handle the communication between departments or manage the RAC time constraints, and it wouldn’t connect our documents and processes. Using the OnBase software, when a RAC auditor puts in a request, we’re ready. We’re prepared to give them all the information they need within the deadline and without taking up a lot of staff time.”
– Bob Wiederhoeft, director of applications Aspirus Wausau Hospital, Wausau, Wis.

“The charge capture tool that we utilized (CAAT technology), gives us, as internal auditors, instant credibility with administration/finance and the clinical staff at our hospitals because the tool allows us to perform and identify potential lost charges on 100% of a population of patients rather than just doing a sample audit.  A tool such as this allowed us to find opportunities in a much shorter amount of time that you would ever find just doing sample audits.  The use of the technology has paid for itself many times over and it also minimized false positives.”
– Renee Jaenicke, director of internal audit, Renown Health Network, Reno, Nev.

“The charge capture tool that we utilized (CAAT technology), gives us, as internal auditors, instant credibility with administration/finance and the clinical staff at our hospitals because the tool allows us to perform and identify potential lost charges on 100% of a population of patients rather than just doing a sample audit.  A tool such as this allowed us to find opportunities in a much shorter amount of time that you would ever find just doing sample audits.  The use of the technology has paid for itself many times over and it also minimized false positives.”
– Laurie Robinson, central billing office manager, Jefferson Health System, Radnor, Pa.

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