What are some of the tools and software that you use to support your revenue cycle functions?

PMS systems are central to revenue cycle management, handling tasks such as appointment scheduling, patient registration, insurance verification, billing, and claims management. Examples include Athenahealth, AdvancedMD, and Kareo.

Examples: NextGen, Athenahealth, eClinicalWorks Functions: Scheduling, patient registration, billing, and claims processing. PMS streamlines administrative tasks and integrates with Electronic Health Records (EHR) systems.

I think it is really helpful to use data analytics like Tableau or Reveal to quickly identify coding trends and outliers. It can help focus efforts on what to review and where to audit your records.

Examples: Epic, Cerner, Allscripts Functions: Maintain patient medical records, ensure accurate coding for billing, and integrate clinical and financial data.

EHR systems store patient health records electronically, facilitating documentation, information sharing, and clinical decision-making. Integration with PMS software ensures seamless data flow between clinical and administrative functions. Examples include Epic, Cerner, and Allscripts.

Coding and billing software play a pivotal role in healthcare administration, providing numerous benefits. This technology not only minimizes coding errors and denials but also enhances coding productivity and quality. Through automation, billing processes and workflows become more efficient, contributing to improved accuracy and compliance. The software serves as a catalyst for generating accurate invoices for patients and payers by translating clinical services into standardized codes. Moreover, its impact extends to increasing reimbursement rates and optimizing cash flow, making it an integral tool for healthcare organizations aiming for precision, efficiency, and financial health in their coding and billing practices.

These tools assist with medical coding, charge capture, and claim generation to ensure accurate billing and compliance with coding standards. They may include features such as code lookup, coding guidelines, and compliance checks. Examples include EncoderPro, Find-A-Code, and AAPC Coder.

Examples: Kareo, AdvancedMD, DrChrono Functions: Automate the billing process, submit claims to payers, track claims status, and manage denials and re-submissions.

RCM software automates and streamlines revenue cycle processes, including claims submission, denial management, payment posting, and reporting. These platforms often integrate with PMS and EHR systems to provide end-to-end revenue cycle solutions. Examples include Waystar, Meditech, and NextGen Healthcare.

Claims management software serves as a powerful asset for efficiently handling the submission, tracking, and overall management of claims to payers. Its capabilities extend to validating and scrubbing claims pre-submission, monitoring and following up on claim status, and identifying and resolving errors and rejections. Additionally, the software enables the streamlined appeal and resubmission of denied claims, ultimately reducing claim processing time and costs. The comprehensive features offered by such software contribute significantly to the optimization and efficiency of the entire claims management process.

Claim management software plays a pivotal role in efficient healthcare administration. Here’s how it streamlines the process: Validation and Scrubbing: Ensures claims are error-free before submission. Status Monitoring: Real-time tracking and follow-up on claim progress. Error Resolution: Identifies and rectifies claim errors and rejections. Appeals Handling: Facilitates appeals for denied claims. Efficiency Boost: Reduces processing time and costs.

Examples: Experian Health, Change Healthcare, R1 RCM Functions: Comprehensive RCM solutions covering patient access, charge capture, coding, billing, and payment posting.

Payment processing solutions enable secure online payments, credit card processing, and electronic fund transfers for patient payments and insurance reimbursements. Integration with PMS and RCM systems streamlines payment posting and reconciliation. Examples include Payspan, InstaMed, and Square for Healthcare.

Examples: Square, Stripe, InstaMed Functions: Facilitate patient payments through various methods (credit card, ACH, online payments), and integrate with billing systems for seamless payment posting.

As an organization that focuses on finding and recovering provider lost revenue like lost charges, coding errors, and previously unidentified underpayments cutting edge analytics/reporting is critical to our success. Identifying opportunities and trends within hundreds of thousands of claims and across payors and financial classes requires advanced modern tools. We have tried many platforms over the past few years including Tableau, Python, and R but ultimately landed on Power BI. It work’s incredibly well for us and also assists with aged AR collection efficiency and both internal and customer reporting. We are now closely evaluating MS Fabric as our next iteration of analytics tool implementation.

In Saudi, there are a few Payers being ahead of the curve in leveraging analytics. To truly compete, the healthcare providers must embrace data-driven strategies within their RCM systems, especially when it comes to procedure costs. Integrating analytics tools enable us to: Pinpoint variations in procedure unit costs across different diagnoses, doctors, & speciality. Track trends and benchmark our performance against industry standards. Proactively eliminate chances for technical/medical rejection at claim level. Remember: integrating analytics into RCM systems, with a specific focus on procedure cost analysis, is not just a smart move – it's essential for staying ahead of the curve and thriving in the ever-evolving healthcare landscape.

Analytics and reporting tools offer insights into key performance indicators (KPIs), revenue trends, claim status, and reimbursement rates. They enable data-driven decision-making and proactive management of revenue cycle processes. Examples include Tableau, Power BI, and QlikView.

Examples: Tableau, Qlik, Power BI Functions: Provide insights into financial performance, identify trends, and generate reports to monitor key performance indicators (KPIs).

Patient engagement platforms enhance communication and interaction with patients throughout the revenue cycle, from appointment reminders and pre-registration to billing inquiries and payment plans. Examples include Phreesia, Solutionreach, and Relatient.

All of this software is great, if people are well trained enough to use it. Most denials come from incorrect information on the front end. FinThrive Learn is a great tool to train all parts of Rev Cycle on how to do their job. It also teaches people how their role affects the rest of Rev Cycle, even tucking in compliance and leadership courses.

Examples: Waystar, SSI Group, Quadax Functions: Track, analyze, and manage claim denials, provide root cause analysis, and recommend corrective actions.