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Revenue Cycle Management | News, Analysis, Insights - HIT Consultant

Optimizing Revenue Cycle Management – What Will It Take to Get There?

by Stacy Leidwinger, VP of Product, Nuance’s Document Imaging Division 09/04/2018 Leave a Comment

The U.S. healthcare system is undergoing a major transformation, from many freestanding hospitals and individual practices to fewer large, integrated healthcare systems. One motivating factor is the promise of greater efficiencies when it comes to delivering more holistic patient care and improving core operational processes. Revenue cycle management is one process that’s primed for improvement. Poor billing practices can cost hospitals millions of dollars due to lost reimbursement or the imposition of fines, which can undermine patient care quality and erode the operational advantages that expansions and mergers were intended to create. What are the ongoing trends making revenue cycle management so challenging? Disjointed front-end and back-end processes – Revenue cycle management is traditionally separated into front- and back-end functions. The front-end is patient-facing and includes administration, intake documents and the confirmation of coverage eligibility, while the back-end includes payer coordination, claims reimbursement, denial communications and ultimately, collection. With patients assuming more responsibility for out-of-pocket expenses, the first step to improving the revenue cycle is maximizing patient collections. The best chance for this lies in collecting payments as early as possible in the patient interaction. According to one recent survey, 85 percent of healthcare organizations say that collecting payments from patients after they have left the facility is a difficult task. Hospitals need to commence billing processes immediately at patient admission, which requires better integration between front- and back-end workflows. Electronic or digitally-based workflows are intrinsically more efficient and secure than paper-based workflows since they don’t rely on paper passing hands and because there is less risk of document misplacement. IT and Toolset Limitations – Successful revenue cycle management has traditionally depended on a strong supporting healthcare IT infrastructure as well as a solid base of highly fluent administrative knowledge workers, who understand the intricacies of working with various types of payers. Unfortunately, many hospitals do not have the resources to invest in the dedicated on-site infrastructure needed to expedite revenue collection and claims management. Hospitals should also train staff members to code and submit claims as accurately and efficiently as possible. The lack of training is often the difference between a fast, efficient claims reimbursement and a potentially time-consuming kick-back. It is also important for knowledge workers to have “DIY” capabilities when it comes to directly hand-picking their own workflow functions to secure the capabilities they need quickly. Back-end staff may include an electronic signature capability in their workflow, which allows supervisors to verify the authenticity of a claim and sign-off, even if they are traveling or on a mobile device. If software tool is available as part of a larger, pre-approved menu, this will also reduce the threat of “shadow IT” - when staff use technology without IT being aware. Lack of automation – Paper remains ubiquitous in the healthcare enterprise, particularly in the admissions process. Better revenue cycle management requires faster, more efficient digitization of paper-based documents. It is particularly important to quickly incorporate insurance details contained in these documents into streamlined digital workflows. Revenue cycle management can be made more efficient by automating manual data entry. Document conversion and classification can easily convert paper documents to digital form in bulk and route the data to appropriate electronic files and personnel for processing. Advances in machine learning soon will enable scanners to “read” and identify characteristics specific to certain documents. For example, the technology could identify an insurance policy, and route the information appropriately while streamlining the entire claims submission process. Poor provider/payer collaboration – Forward-thinking hospitals are creating new types of streamlined payment processes whose workflows are similar to those integrating front- and back-end claims processing. Tailored workflows can address the unique requirements of individual payers, enabling information exchange and critical communications through a highly secure, digital process. For example, different payers may use a different chain of command or steps for reimbursement approvals. Workflows can be created and modified to adhere to acknowledge this. These provider/payer frameworks also provide end-to-end visibility across the claim lifecycle, allowing providers to take appropriate action to improve collection processes – for instance, identifying and addressing late reimbursements. Increased automation plays a role here as well by alerting knowledge workers when a particular claim reimbursement is complete, or automatically flagging problems and their source. While the challenges of improving revenue cycle management are abundant, and many organizations aren’t sure where to begin, certain threads are common. These include the need for tighter workflow integration (both within an organization and between payers and providers) and greater empowerment of knowledge workers through automation and simplified workflows. Effective revenue cycle management is critical to the success of the healthcare enterprise in its mission to promote high standards of patient care and satisfaction and operational excellence. Most organizations have room for improvement, and the capabilities described here are a good starting point. Stacy Leidwinger, VP of Product, leads the team driving product innovation within Nuance’s Document Imaging Division. She oversees the product roadmap and all phases of the product lifecycle with the goal of planning, launching and managing best of breed software products.

The U.S. healthcare system is undergoing a major transformation, from many freestanding hospitals and individual practices to fewer large, integrated healthcare systems. One motivating factor is the promise of greater efficiencies when it comes to delivering more holistic patient care and improving core operational processes.Revenue cycle management is one process that’s primed for improvement. Poor billing practices can cost hospitals millions of dollars due to lost reimbursement or the
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Revenue Cycle Startup AxiaMed Lands $12.4M for Patient Payment Platform

by Jasmine Pennic 08/21/2018 Leave a Comment

Revenue Cycle Startup AxiaMed Rasies $12.4M for Patient Payment Platform

AxiaMed, a patient payment solution provider has raised $12.4 million in funding from Health Enterprise Partners. AxiaMed credits this investment to rapidly-increasing demand for its proven, secure, SaaS-based payment platform, Payment Fusion. Founded in 2015, AxiaMed’s integrated payments technology platform, Payment Fusion, improves the financial performance of healthcare providers through integration with various revenue cycle, practice management, EHRs and other software systems, enhancing
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Patientco Lands $28M to Reimagine the Patient Financial Experience

by Fred Pennic 07/26/2018 Leave a Comment

Patientco Lands $28M to Reimagine the Patient Financial Experience

Patientco latest Series B funding fuels expansion of patient billing and payments technology platform focused on creating a smarter patient financial experiencePatientco, an Atlanta, GA-based next-generation patient billing and payments technology company has raised $28 million in Series B funding led by private equity firm Accel-KKR. The round also included participation from BlueCross BlueShield Venture Partners / Sandbox Advantage Fund. Patientco plans to use the funding to accelerate expand
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Apixio Unveils AI-Powered Risk Adjustment Auditing Solution for Plans & Providers

by Fred Pennic 07/25/2018 Leave a Comment

Apixio Unveils AI-Powered Risk Adjustment Auditing Solution

Apixio Inc., the data science company for healthcare, today announced availability of the first-ever AI-powered solution to help health plans and provider organizations to undertake internal audits of their risk adjustment payment data with increased accuracy and in far less time than traditional methods. Medicare is increasing the frequency of health plans audits offering Medicare Advantage (MA) products to ensure correct payments. Given the potential revenue impact, it typically takes health
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8 Tips for Urgent Care Clinics to Optimize Revenue & Remain Profitable

by Monte Sandler, Executive VP of Revenue Cycle Management at DocuTAP 07/23/2018 Leave a Comment

8 Best Practices for Urgent Care Clinics to Optimize Revenue & Remain Profitable

As the 2017-18 flu season winds down, it’s become clear that it was one for the record books. With the onset coming early and strong, emergency departments, primary care physicians, and urgent care clinics all over the country were overrun with patients waiting in line to see a doctor.While this had a negative impact on a large portion of the U.S. population, anyone involved in the on-demand healthcare space knows that the flu season and resulting increase in patient volume tends to feed the
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The Patient Experience and…Revenue Cycle Operations? The Two Are More Interlinked than You Might Think.

by Florian Otto, CEO at Cedar 07/16/2018 Leave a Comment

The Patient Experience and…Revenue Cycle Operations?

Think back to the last time you read a negative review about a restaurant. After reading the review, you probably dismissed the restaurant and considered other places to eat.Now, imagine you’re a patient considering options for an outpatient procedure and you came upon negative reviews about a provider. Chances are, you probably skipped that provider and opted for a consult with someone else. As providers, how can we fix this?  Now, more than ever, patient satisfaction matters, especially given
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Change Healthcare Launches Consumer Payment Solution to Transform Their Financial Experience

by Fred Pennic 07/10/2018 Leave a Comment

Change Healthcare Acquires Credentialing Tech Docufill to Improve Administrative Efficiency

This week, Change Healthcare unveiled Member Healthcare Payments, a consumer payment solution that enables health plans to display consolidated patient financial information in a single destination, and empower consumers to better understand and manage their healthcare finances. Additionally, Member Healthcare Payments helps health plans better support providers by collecting patient payments, which can eliminate the provider's need to collect those payments.The first health plan to utilize
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DrChrono EHR Integrates with Collectly to Automate Billing & Collections for Practices

by Jasmine Pennic 07/09/2018 Leave a Comment

drchrono EHR

DrChrono Inc., the company enabling the medical practice of the future, today announced a new partnership withCollectly, a fellow Y Combinator company that streamlines the billing and collection process for healthcare companies.Collectly digitizes paper bills and works with practices to send patient billing statements and collection notices electronically via text or email.  Within the message is a link for patients to go straight to a patient portal to see their statement and instantly make a
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Report: Healthcare Organizations are Seeing Improved Profits from Value-based Care Contracts

by Fred Pennic 06/29/2018 Leave a Comment

Value-based Care Contracts: 46% of Providers are Seeing Improved Profits

46% of healthcare organizations see value-based care contracts improving profitability versus 23% two years ago. Healthcare organizations are more optimistic about how value-based care will affect their finances, according to a poll of accounting and finance employees on a webcast that KPMG hosted. Government spending on healthcare through Medicare, Medicaid, Veterans Administration and other programs have been shifting to value-based payment models in an attempt to improve efficiency and tie
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Solving the Patient Access Labor Supply Challenge

by Beth Ottinger & Michael Maggard 06/27/2018 Leave a Comment

Solving the Patient Access Labor Supply Challenge

Providers are struggling to stay profitable while also striving to keep patient satisfaction from being negatively impacted. Denials are on an upward trend, payors are becoming tighter around what is demanded of the providers, and patients are being squeezed to pay more out-of-pocket with the ongoing shift to self-pay and high-deductible plans.What many may not realize is that these financial challenges rear their head from the moment the patient walks through the door or schedules an
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