6 Healthcare Revenue Cycle Management Systems To Watch
Healthcare professionals look to the latest RCM platforms to help them process patients efficiently while satisfying new regulations. We compare choices in this critical category.
![](https://eu-images.contentstack.com/v3/assets/blt69509c9116440be8/bltc0182b2356ae8eed/64b83949410a1b4c0bd7459b/IW_generic_image.png?width=700&auto=webp&quality=80&disable=upscale)
Choosing the right revenue cycle management (RCM) system can make or break a hospital or physician practice. The moment a patient makes a doctor's appointment or enters the hospital, the RCM system kicks in. What happens after that depends a lot on whether there is an effective and transparent marriage between claims data, clinical data and IT.
According to the 2012 Black Book IT Yearbook for accountable healthcare organizations (ACOs), 95% of hospital and healthcare system executives polled said they were accelerating their acquisitions of health information exchange (HIE), electronic health record (EHR), clinical decision support, care coordination, business intelligence, and complex revenue cycle management systems to prepare for ACO and other care delivery models pegged to new reimbursement methods.
So what should a hospital, traditional practice, or ACO look for in a RCM program?
According to Jane Sarasohn-Kahn, health economist, management consultant and Health Populi blogger, today's health providers need to focus on revenue cycle workflow because they will be caring for patients over the long term, not episodically. "That means looking horizontally at the value-chain of care, from pre-encounters through to the post-encounter administrative tasks," she said. "At the front end, the provider must capture and clarify the insurance and payment provisions for the patient.
"Throughout this chain, RCM systems can help health providers pinpoint areas for cost improvement in real time," said Sarasohn-Kahnsays. "The systems should also be able to integrate clinical and care management information along with the financial information along the patient's journey."
Sarasohn-Kahn pointed out that predictive modeling is emerging out of big data sets to help providers spot, say, the top 5% of patient "high utilizers" in order to identify opportunities for better care management -- for example, prescribing a remote home health monitoring device for patients with a pattern of hospital readmissions for congestive heart failure.
Real-World Needs
For Sharon Hawthorne, business manager at Dr. Rochelle G. Catus' Ob/Gyn practice in St. Louis, Missouri, there are two sides to revenue cycling. There is "revenue cycle from the business side and revenue cycle from the clinical side," she said. "And from a business side, scheduling is one of the important features, and complex scheduling is a feature that is necessary because it starts from the appointment."
It's imperative to accurately capture patient demographics and insurance, and know that you are working with a patient with whom you are contracted, said Hawthorne. "To schedule a patient who you do not have a contract with might not be in the best business interests for that practice," she said. Catus' practice uses ADP's AdvancedMD RCM product.
A good revenue management system effectively deals with different insurance carriers, Hawthorne added. "You need to know all the different nuances and rules that carriers have when you're processing claims, and a good revenue management system has the ability to have those rules so that you don't have to have your employees memorize them." she said.
Hawthorne also pointed out that mobile applications are playing a greater role in revenue cycle management. Her practice, for example, is currently using tablet computers. "As a manager, the ability to look at my company from anywhere I am is important because sometimes I'm not in my office; I'm assisting in another office," she said.
Dan Johnson, president of RCM vendor Experian Healthcare, told InformationWeek Healthcare that he frequently hears from hospitals and practices that they are looking for tools that have been used by financial services companies and modified to be used in health care. "I've heard that more in the last year; there's a recognition that they lack those tools," said Johnson.
Johnson said he's also noticed there's a new focus on revenue cycle tools that work in both the hospital and the physician practice, and that integrate data. "[M]any hospitals [are] buying physician practices and so many of these organizations [are] forming hospital physician partnerships," Johnson said.
Another emerging issue, according to Johnson, is the need for a higher degree of electronic authentication for access into medical records systems, an issue that has been driven by Meaningful Use Stage 2 standards. "That is requiring a higher level of authentication for access to medical records systems, and this has started with CMS deploying ID proofing for Medicare recipients to access the CMS website where medical data exists," he said.
Revenue cycle management can be complicated, but it's a necessary part of running a successful healthcare organization, especially with changing federal requirements. This overview of six RCM systems will help you make an informed decision.
McKesson's Revenue Cycle Management offers users the ability to model and forecast performance on the fly. The idea, according to McKesson, is to enable providers to assess reimbursement risk under Medicare's Pay for Performance model compared to benchmarks; to model improvement at the detailed indicator level; and to immediately quantify the financial impact.
McKesson's RCM offering is divided into five parts:
-- The Horizon Business Folder, a hospital document management system that provides automation and business process optimization to help organizations manage patient accounting documentation.
-- Paragon Hospital Information System, a Microsoft Windows-based, fully-integrated clinical and financial information system specifically designed to meet the needs of critical access in rural and community hospitals of all sizes.
-- McKesson Intelligent Coding, which optimizes revenue and reduces compliance risk for coding and charge capture in key outpatient areas.
-- McKesson Performance Analytics, a set of tools that turns an organization's data into actionable intelligence.
-- McKesson Revenue Management Solutions, medical billing and practice management services to help improve revenue, lower costs and reduce risks.
The way Experian president Dan Johnson sees it, healthcare has historically looked in the rear-view mirror when managing its business. Now he sees the need to provide real-time data and even some accurate forecasts for the near term.
As he explains, "[This] is a model changer because hospitals routinely look at how their payer collections and their patient collections were last October when setting expectations for what they will be this October, and that's a terrible model. So that's changing quickly."
Experian's core business provides revenue cycle tools that optimize payments from payers and patients to hospitals and clinics. Johnson said that Experian is taking its electronic authentication product into the healthcare market to help the industry comply with Meaningful Use.
In March 2013, during HIMSS13, the company will launch an ID proofing solution for hospitals that Johnson says is driven by Meaningful Use Stage 2 requirements. The company won a contract with the Center for Medicare & Medicaid Services (CMS) to serve as the vendor that provides ID proofing to the CMS website for Medicare recipients.
Experian is also embracing mobile computing. "That's been a big push of ours over the last year," said Johnson. Experian collects hospital financial data and delivers it through iPad apps to financial executives so they know, in real time, how much charity care they've deployed month-to-date, for example, or what their patients' collections are at a certain point in the month. Johnson also emphasized that the company is pushing a lot of benchmarking data out into the industry to help hospitals and clinics understand how they are performing compared to their peers in the marketplace.
GE Centricity Business says its RCM product provides "a flexible system design, scalability and rich functionality while infusing providers' financial operations with quality and efficiency."
Customer feedback has resulted in a greater focus on open connectivity, smart workflows and standards-based architecture that the company says allows customers to create a complete clinical and financial environment where they can seamlessly connect to any EMR or outside to the community.
The system is designed to help healthcare organizations address regulatory challenges such as EDI 5010, prepare for ICD-10, and stay ahead of evolving payment methodologies associated with ACOs. Centricity Business acknowledges that larger healthcare organizations require enterprise-ready revenue cycle tools across their continuum of care.
Centricity boasts an integrated inpatient and ambulatory revenue cycle management across multiple locations. It also supports multiple reimbursement models, including fee-for-service, capitation, bundled payments, pay-for-performance and shared savings for accurate reimbursements and higher profitability. Its automation of the revenue cycle helps improve an organization's performance in key metrics such as accounts receivable days outstanding, said Centricity.
Among Centricity Business's customers are Sharp Healthcare, Healthcare Partners, and Orlando Health.
According to Jim Elliot, VP of marketing for ADP AdvancedMD, the RCM market is a dynamic environment where rules are constantly changing. "There's quite a mismatch between the complexity of claims processing and the systems of the payers and the doctors and practices in hospitals trying to get their money of out the system," Elliot told InformationWeek Healthcare. He believes the changing landscape is driving the need for RCM systems that are up to par with the payer's system and the government compliance requirements on an ongoing basis.
Born as a Web-based application, ADP's AdvancedMD software has been around for more than 10 years. At the core of the software is a cloud-based practice management and billing system that providers can access from anywhere.
About 350 medical billing companies use the ADP AdvancedMD software as their core business engine, and Elliot plans to roll out mobile applications to make access easier. It has an iPad-based charge entry system that is currently in beta testing.
Originally designed as an in-house RCM system for Tenet Healthcare, Conifer's system now serves the entire healthcare industry. Conifer Health Solutions was launched in 2008 as a healthcare services company devoted to providing revenue cycle transformation and patient communications services to hospitals and health systems nationwide.
"We aren't developing software or managing IT, and we aren't consultants offering a strategy for someone else to build and manage," said senior director of communications John Hoffmann. "We are a healthcare services provider -- offering processes and technology [and] working to improve operational performance for our hospital clients so they can better market to their community, communicate effectively with patients, and support patient financial administration," he said.
Conifer's offerings have expanded to support health information management and ICD-10, risk and capitation management, ACO, and bundled payment processing, as well as ethics and compliance program effectiveness. Conifer, which employs 4,000 workers and earns $18 million in net revenue annually, serves more than 380 healthcare entities and operates seven national "centers of excellence." It processes 9.5 million patient accounts annually and manages 600,000 patients.
Emdeon contends that hospitals are looking for a partner that has industry breadth and knowledge. The company offers complete revenue cycle solutions that aid hospitals with their challenges while also providing a foundation for future models that are emerging from regulations like the Affordable Care Act, it says.
Emdeon's technology-enabled services directly connect hospitals to the largest all-payer network of commercial and government health plans nationwide, it says. This provides its customers with comprehensive eligibility and benefits verification; and submission, remittance, and payment of medical claim services. Its direct connections enable it to provide hospitals with the broadest array of transactions, says Emdeon, including real-time response, extended content, and advanced editing solutions designed to speed payment and enhance profitability.
Emdeon services include eligibility and benefits verification, patient responsibility estimation, claims management, remittance and payment management, payment integrity services, patient billing, and payment revenue cycle analytics.
Emdeon contends that hospitals are looking for a partner that has industry breadth and knowledge. The company offers complete revenue cycle solutions that aid hospitals with their challenges while also providing a foundation for future models that are emerging from regulations like the Affordable Care Act, it says.
Emdeon's technology-enabled services directly connect hospitals to the largest all-payer network of commercial and government health plans nationwide, it says. This provides its customers with comprehensive eligibility and benefits verification; and submission, remittance, and payment of medical claim services. Its direct connections enable it to provide hospitals with the broadest array of transactions, says Emdeon, including real-time response, extended content, and advanced editing solutions designed to speed payment and enhance profitability.
Emdeon services include eligibility and benefits verification, patient responsibility estimation, claims management, remittance and payment management, payment integrity services, patient billing, and payment revenue cycle analytics.
Choosing the right revenue cycle management (RCM) system can make or break a hospital or physician practice. The moment a patient makes a doctor's appointment or enters the hospital, the RCM system kicks in. What happens after that depends a lot on whether there is an effective and transparent marriage between claims data, clinical data and IT.
According to the 2012 Black Book IT Yearbook for accountable healthcare organizations (ACOs), 95% of hospital and healthcare system executives polled said they were accelerating their acquisitions of health information exchange (HIE), electronic health record (EHR), clinical decision support, care coordination, business intelligence, and complex revenue cycle management systems to prepare for ACO and other care delivery models pegged to new reimbursement methods.
So what should a hospital, traditional practice, or ACO look for in a RCM program?
According to Jane Sarasohn-Kahn, health economist, management consultant and Health Populi blogger, today's health providers need to focus on revenue cycle workflow because they will be caring for patients over the long term, not episodically. "That means looking horizontally at the value-chain of care, from pre-encounters through to the post-encounter administrative tasks," she said. "At the front end, the provider must capture and clarify the insurance and payment provisions for the patient.
"Throughout this chain, RCM systems can help health providers pinpoint areas for cost improvement in real time," said Sarasohn-Kahnsays. "The systems should also be able to integrate clinical and care management information along with the financial information along the patient's journey."
Sarasohn-Kahn pointed out that predictive modeling is emerging out of big data sets to help providers spot, say, the top 5% of patient "high utilizers" in order to identify opportunities for better care management -- for example, prescribing a remote home health monitoring device for patients with a pattern of hospital readmissions for congestive heart failure.
Real-World Needs
For Sharon Hawthorne, business manager at Dr. Rochelle G. Catus' Ob/Gyn practice in St. Louis, Missouri, there are two sides to revenue cycling. There is "revenue cycle from the business side and revenue cycle from the clinical side," she said. "And from a business side, scheduling is one of the important features, and complex scheduling is a feature that is necessary because it starts from the appointment."
It's imperative to accurately capture patient demographics and insurance, and know that you are working with a patient with whom you are contracted, said Hawthorne. "To schedule a patient who you do not have a contract with might not be in the best business interests for that practice," she said. Catus' practice uses ADP's AdvancedMD RCM product.
A good revenue management system effectively deals with different insurance carriers, Hawthorne added. "You need to know all the different nuances and rules that carriers have when you're processing claims, and a good revenue management system has the ability to have those rules so that you don't have to have your employees memorize them." she said.
Hawthorne also pointed out that mobile applications are playing a greater role in revenue cycle management. Her practice, for example, is currently using tablet computers. "As a manager, the ability to look at my company from anywhere I am is important because sometimes I'm not in my office; I'm assisting in another office," she said.
Dan Johnson, president of RCM vendor Experian Healthcare, told InformationWeek Healthcare that he frequently hears from hospitals and practices that they are looking for tools that have been used by financial services companies and modified to be used in health care. "I've heard that more in the last year; there's a recognition that they lack those tools," said Johnson.
Johnson said he's also noticed there's a new focus on revenue cycle tools that work in both the hospital and the physician practice, and that integrate data. "[M]any hospitals [are] buying physician practices and so many of these organizations [are] forming hospital physician partnerships," Johnson said.
Another emerging issue, according to Johnson, is the need for a higher degree of electronic authentication for access into medical records systems, an issue that has been driven by Meaningful Use Stage 2 standards. "That is requiring a higher level of authentication for access to medical records systems, and this has started with CMS deploying ID proofing for Medicare recipients to access the CMS website where medical data exists," he said.
Revenue cycle management can be complicated, but it's a necessary part of running a successful healthcare organization, especially with changing federal requirements. This overview of six RCM systems will help you make an informed decision.
About the Author(s)
You May Also Like