Revenue cycle management undergoes changes

Outside forces are shaping how healthcare organizations are managing their revenue cycles. Regulation changes and the consumer-directed healthcare movement are the main agents of change.

Recent regulation changes in claim form UB04 and the release of the National Provider Identifier data dissemination policy have created misunderstandings, said Claudia Birkenshaw, executive vice president of BridgeFront, a Beaverton, Ore.-based healthcare education firm.

The importance of being able to keep up with changes in a healthcare organization’s processes and systems can’t be understated. If NPI numbers for hospitals and physicians don’t match or both numbers aren’t on claims forms, payments will be delayed. If claims scrubbers aren’t modified, payment snafus will result.

“They have to make the effort to get the changes corrected, simplify the process and align the changes with how things are done,” she said.

The technology piece is in place, as patient financial management system vendors deal with the onslaught of regulatory issues, said Paul Pitcher, director of financial systems for KLAS Enterprises.

“It’s good for vendors to keep up with the regulatory changes,” he said. “Unfortunately, most of the R&D is disproportionately placed in this area and not enough  is spent on product enhancement, advancing the product itself.”

While technology updates and testing are critical, the need to educate revenue cycle management and clinical staff on processes and procedures is equally important, Birkenshaw said.

Courtney Hoagland, principal with Deloitte Consulting, said good processes are vital to revenue cycle management. She emphasized that process must be standardized and put into place ahead of technology deployment.

Organizations will run into trouble if they don’t address core processes such as front-end, centralized registration and patient liabilities.

As revenue cycle management becomes more automated, Hoagland said organizations still need to focus on good training to achieve follow through on good processes.

Consumerism and transparency also are pressing issues, said David Hammer, vice president of revenue cycle solutions for McKesson.

“They’re being eagerly embraced by leading institutions that have already differentiated themselves with cost, patient satisfaction and quality reporting,” he said.

Payers are being progressive about putting prices on the Web and offering price comparisons. Hospitals, in response, must make sure their quality information is posted and that they change their prices to ensure that apples-to-apples comparisons can be made.

Consumerism and transparency are bringing about an awareness of the need to adopt next-generation revenue-cycle systems, Hammer said. The goal is to have complete integration between revenue-cycle systems and clinical systems, thereby eliminating the current trend of employing bolt-on solutions.

Hammer said the push for integration doesn’t imply there has to be a rip-and-replace mentality. Healthcare organizations have been able to cobble together bolt-ons to achieve best practices in such areas as eliminating late and lost charges and preventing clinical denials.

While leading healthcare IT vendors are putting out integrated systems, Hammer said, “The market is not successful yet. The struggles are in technology. The systems aren’t quite ready for prime time.”

The push does indicate that the pendulum is swinging back from an emphasis on clinical to financial systems.

Consulting Services

American Healthcare Solutions

American Healthcare Solutions provides consulting services in evaluation, leadership development and implementation.

Deloitte & Touche USA LLP

Healthcare consulting services in strategic decision and operational areas include pricing and reimbursement strategy, distribution strategy, contract strategy, customer support, order management and contract administration.

Ernst & Young

The professional services organization’s Health Sciences Advisory Services provides services for revenue management, financial performance, regulatory reporting and compliance, and managed care.

KPMG

KPMG helps healthcare organizations protect their assets by helping them measure, monitor and manage risks to their organizations. Its risk advisory services focus on helping clients improve their key business function processes and controls – finance, operations, information, internal audit, regulatory compliance and investigation, treasury and reporting.

Medaphase

Comprehensive business service to physician groups and hospitals, Medaphase’s services help providers manage administrative, clinical, financial and operational information. Its core services include coding, billing, consulting and documentation and coding audits.

PricewaterhouseCoopers

Global accounting and consulting firm offers a global network of healthcare industry professionals to provide assurance, tax and business advisory services.

Revenue Cycle Solutions

Consulting firm that provides services for revenue cycle reviews, interim patient account management services and customized revenue-related projects.

Consulting Services and Products

Accenture

Accenture provides revenue transformation methodologies and the Accenture Revenue Cycle Management Workflow Tool, which enables services such as denial management programs, patient payment and cash acceleration strategies, and vendor contract management.

Accuro Healthcare Solutions

Accuro Healthcare Solutions’ revenue cycle solutions include a comprehensive suite of Web-based tools and consulting services.

Athenahealth

Athenahealth provides Web-based practice management software, database of current, real-time payer rules and regulations, and a comprehensive billing and collections services.

IBM

IBM provides strategic outsourcing solutions for healthcare providers that combine information technology, tools and consulting services in a flexible, customized, healthcare provider-specific format. IBM provides applications development and management. It facilitates e-commerce and business-to-business capabilities by integrating business databases, applications and Web site infrastructure.

Ingenix

Ingenix creates sound receivables management program by using operational and data analyses, and performance and productivity benchmarking to identify and prioritize operational problems in revenue-cycle functions. Ingenix also provides consulting services.

Keane

Keane’s holistic approach to improving the revenue cycle process encompasses solutions and comprehensive business process analyses consulting.

McKesson Provider Technologies

McKesson Provider Technologies provides healthcare IT and automation solutions such as revenue cycle management and full services solutions such as consulting and outsourcing.

Purkinje

CareSeries Plus combines practice management and electronic medical record software to reduce costs and maximize income. Purkinje also provides services, using its team of billing and coding experts, to help manage all areas of accounts receivables.

Perot Systems

Business Process & Revenue Cycle Solutions: Perot Systems’ solutions include services and software. The company’s revenue cycle management experts design solutions such as A/R resolution projects, outsourcing and individual projects such as computer conversion assistance.

Products

Boston Software Systems

Boston Workstation
This healthcare revenue cycle management automation and integration tool enables more accurate billing and faster reimbursements.

Catalisse

Revenuity
Revenuity is a claims processing tool.

Cerner

Cerner combines its Clinically Driven Revenue Cycle with its Cerner Millennium health information technology computing platform for claims submission. Cerner also provides professional services as well as support and hosting services.

Companion Technologies

EnterprisEDI
EnterprisEDI automates and streamlines revenue generation processes such as eligibility, claims submission, patient correspondence and compliance checking.

DB Healthcare Solutions

RASi
Product offerings include enterprise document management for patient accounting and medical records for the elimination of paper-related costs and tasks, and comprehensive patient accounting viewing, respectively.

Eclipsys

Sunrise Access Manager/Patient Financial Manager
Sunrise Access Manager/Patient Financial Manager provides healthcare organizations with a comprehensive, enterprise-wide enterprise master person index (EMPI), scheduling, registration and patient accounting solution.

Emdeon

Revenue cycle management solutions are in the areas of patient access management, clinical management, third-party billing management, patient billing and payment, payment posting and denial management.

Epic Systems Corp.

Resolute Professional Billing, Resolute Hospital Billing
Resolute Professional Billing and Resolute Hospital Billing coordinate inpatient and outpatient billing for hospitals, and provide comprehensive billing and accounts receivable tools for ambulatory care environments and hospital professional fees, respectively.

Hyland Software

OnBase
OnBase is an integrated document management software that consolidates and manages paper-based and electronic records. It improves the integrity of patient financial records, which can help reduce days in Accounts Receivable and lower discharge not final billed.

MedAssets

MedAssets Net Revenue Systems
MedAssets’ Net Revenue Systems is a tool suite designed to improve data integrity, billing compliance, and management of claims denials.

MedeFinance

A suite of Web-based business intelligence software that helps providers reduce bad debt, accelerate cash, improve operating margins, track financial performance and drive accountability throughout the organization.

Meditech

Meditech’s Revenue Cycle product helps organizations with patient billing management, from the issuing of referrals to bill and collection generation for timely reimbursement for services rendered.

Ontario Systems

Activa Healthcare System
A bolt-on system that provides self-pay collections, third-party insurance follow-up and agency management features ensure accounts are worked to your standards.

QuadraMed

QuadraMed’s Patient Revenue Management solutions help enable timely, accurate and complete billing. The Care-Based Revenue Cycle solutions have HIPAA EDI transaction sets embedded in them.

Siemens

Siemens Medical Solutions Health Services provides consulting and IT services, and revenue cycle management solutions.

Thomson

Medstat Revenue Cycle Management
The solution lets hospitals identify revenue cycle risk points, tracking systems and processes to prevent denied claims. The tool has on-the-spot payment calculation functionality and alert systems to signal when services rendered exceed contractual allowances and help target methods to manage patient treatment in compliance with payer contracts.

Verus

vPAC
vPAC provides tools for collecting patient-owed fees in an online, real-time environment. vPAC ROI analysis tools find savings in cost avoidances, cash flow improvements, paper bill opt out and increased collections.