The changing face of RCMUnder self-pay structures, a significant amount of payments for medical costs is shifted from the commercial insurance company to the patient. This increases the need for hybrid performance in revenue cycle management solutions, said Brad Lund, executive director of the Healthcare Billing and Management Association. “If you send a clean claim to the insurance company, they send back a check, whereas the self-pay side is much more challenging,” he said. HBMA represents companies that manage revenue cycle operations for physician groups – a membership that accounts for 30 percent of all claims in the industry. Lund said the association is educating providers on properly managing claims ahead of major transitions, including RAC and ICD-10 – both of which, like self-pay, will have a great impact on RCM technology. |
 The onset of new programs like Medicare’s RAC and the ICD-10 coding system will keep revenue cycle managers busy. |
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3 TRENDS TO WATCH
Brad Lund, executive director of the Healthcare Billing and Management Association, sees these three trends affecting revenue cycle management:
1.RECOVERY AUDITS: Medicare’s RAC audits are affecting nearly every financial process for healthcare providers. 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 ready for ICD-10 will leave 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. |
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VENDOR SHOWCASE |
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Alpha II |
Caremedic Systems |
Concuity |
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Craneware |
Eclipsys |
Hyland Software |
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McKesson |
MedSynergies |
MPV |
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Navicure |
NextGen Healthcare Information Systems |
PCG Software |
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Select Health Management |
ZirMed |
Picis CareSuite |
User Reviews |
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 "MPV streamlines revenue cycle management by giving us the ability to automate time-consuming manual processes, minimize errors and more accurately estimate a patient’s out-of-pocket expenses. Through our use of MPV Patient Portion Pricer, we’ve experienced a 12 percent increase in patient collections and a 13 percent decrease in bad debt."Lisa S. Conner, CMPE, CASC, business office manager, Lake Charles Medical & Surgical Clinic. |
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 "Craneware’s Chargemaster Toolkit identified a $3.6 million revenue opportunity from 55 radiology charges that were priced below the Medicare APC.”Brian Patterson, Chargemaster coordinator, University Health Care System, Augusta, Ga. |
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| "Prior to implementing CareMedic’s eFR for denial management and reporting, denials for Renown Health were reported at 22 percent and averaged approximately $22 million a month. Since implementation in 2006, we have seen a dramatic decrease in our denials and are proud to report our denials at 3.5 percent with an average $5 million a month in denied charges. We attribute this decrease to CareMedic’s denial management and ease of reporting through the eFR. We are able to easily identify and track our denials using reliable and consistent methods." Yvonne Clark, systemadministrator/patient financial services, Renown Health. |
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| “The ROI for Clear Contracts was realized in a very short time frame and we are very satisfied with the results. Our CFO had counted on an additional $1.5 million in recoveries and we have been able to deliver that and then some, making this the most successful project for the hospital this year.” Paula Wilke, administrative director, Patient Financial Services, Edward Hospital & Health Services. |
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| ““In the past, if someone needed documents for billing a collections appeal or insurance referral authorization, they had to request a paper chart located in a facility a couple of miles across campus. Because it’s paper – not to mention the geographical barrier – there was delay in receiving the documents. And what’s more, the departments incurred courier costs for the document delivery. There’s also the vulnerability of having only one copy of the paper. Our OnBase system provides redundancy for the information, eliminates the delays and costs of courier service, and possibly most importantly, provides security around our information. And while we can quantify these savings, it’s hard to measure the dollar value of better access to documents needed for billing and collections. But it certainly helps us increase revenue, makes us much more efficient and improves job satisfaction for admissions and patient financial services staff.” Tim Leary, manager, Information Resources, University of Texas Southwestern Medical Center, Dallas, Texas. |
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| “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 percent 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. |
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| “Prior to deploying the Picis Perioperative Dashboard (part of the Picis CareSuite® product family), we had a 45-50 percent first case on-time start range. With the new system, we’ve moved to the 80-85 percent range for first case on-time starts. This significant increase has saved our staff a great deal of time and headache, which has been a much-welcomed boost for employee morale” Janet Burke, Lahey Clinic Medical Center |
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