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So, you’ve weighed your options and decided it’s time to replace your revenue cycle management (RCM) solution. You’re not alone. According to a recent survey, about one out of every five healthcare organizations are planning to replace their current system, too.
What’s causing this trend? Healthcare organizations are preparing for new value-based reimbursements, while still collecting as much revenue as possible under current fee-for-service methods. Lots of RCM solutions simply aren’t up to the challenge of succeeding with both financial models.
At Allscripts, we updated our revenue cycle management solution to help clients meet today’s financial challenges. Our Sunrise Financial ManagerTM solution builds on the successes of Sunrise Patient Financial ManagerTM.
We listened closely to clients about what they needed in future revenue cycle management solutions. We made sure that Sunrise Financial Management could:
– Switch gears smoothly as they move toward value-based care models.
– Natively integrate with clinical information.
– Automate tasks related to eligibility verification, claims preparation, account reconciliation and denial management.
– Make it easy to tailor the application to the workflow needs of their institutions.
From outcomes to income – a healthy financial core at Blessing Hospital
Blessing Hospital (Quincy, IL, USA) transformed its revenue cycle management with solutions from Allscripts. Using Sunrise Patient Financial Manager, and soon migrating to Sunrise Financial Manager, Blessing’s financial solutions natively integrate with its Sunrise clinical solutions.
Blessing automated several tasks, and in six months it was able to improve several financial measures, including a better clean claims rate. To learn more about Blessing’s experience, you can read this recent case study.
U.S. healthcare providers need to collect every dollar owed to them. As their reimbursement models rapidly evolve, you may be asking, “Is it time to replace our revenue cycle management (RCM) solution?”
Experts estimate that if U.S. hospitals do nothing to address the swiftly changing financial environment, they could see a 19% drop in margins over the next 10 years.
Based in part on the HIMSS AnalyticsTM index and other observations, we developed a checklist of the core components of a healthy financial system.
If your RCM solution can’t do these things, it may be time for a change:
1. Offer web services to patients for convenience – Can your patients pre-register, self-schedule and pay bills online? These online conveniences are becoming more important to consumers and help speed the billing process.
2. Verify insurance eligibility in real-time to reduce risk – Your staff and patients should know which services insurance may not cover. Knowing this information in real-time is important.
3. Use rules engines to improve accuracy – Intelligent automation helps us stay on track. It can double-check if the patient owes a co-pay at registration. It can compare claims against contractual terms to identify errors. Best of all, rules can accomplish these tasks more consistently, more accurately and more rapidly than manual processes.
4. Integrate clinical and financial information for faster billing – The ability to share information across care settings enables the provider to capture more charges and prepare for bundled payments and Accountable Care Organizations (ACOs).
5. Work directly with payers to improve efficiency – Some organizations use a third-party clearinghouse to submit claims to payers, accept claims from payers or post payments against receivables. Your claims process will be more efficient and less expensive with an RCM system that can manage these tasks.
6. Provide electronic funds transfer (EFT) for better cash flow – EFTs that third-party payers send directly into your bank account can not only improve cash flow, but are better for your financial reconciliation process.
7. Enable flexibility to address specific needs – Financial teams should be able to quickly build and execute new workflows. For example, a team could design prompts to help customer service representatives quickly answer patient questions about invoices, specific to that organization.
8. Offer an Open architecture for better payment coordination – A service-oriented architecture (SOA) becomes increasingly important in today’s financial environment. For example, if different providers need to share cost and quality information for bundled payments, they can do that easily with an SOA. Or, as hospitals acquire physician practices, an SOA enables them to handle different kinds of claims forms. There are far more options with an SOA than in a traditional RCM system.
To learn more about new revenue cycle management solutions, you can download a recent white paper.
Editor’s Note: John Dragovits and other healthcare IT executives provide more best-practice rev cycle strategies in a recent article for Health Management Technology.