Related Links

Web Seminars

Like all businesses, an abiding concern for health care organizations is how they get paid. Yet, even for the professionals immersed in it, the payment system for health care providers can seem Byzantine. Indeed, a lot of revenue can get lost due to the complexity of the contractual arrangements or the disparity in I.T. infrastructure between payer and provider. To remedy this, one option for providers to consider is revenue cycle management software. Modern revenue cycle management modules are designed to help providers maximize revenue capture and streamline their billing and collection processes. The systems accomplish this by managing payer contracts, creating bills based on clinical documentation, processing claims , and enabling appeals.

Despite the potential, many providers have moved revenue cycle management projects to the back burner. Joel Gardiner, principal in the Health Care Providers practice and national practice leader of revenue cycle management services for New York-based Deloitte, says a variety of political and economic factors are coming into play. With provider investment portfolios dented and overall I.T. spending pinched, funds to finance revenue cycle management initiatives have been harder to come by.

Making the Case

Gardiner sees ample reason why providers should explore investing in revenue cycle management. One reason is largely regulatory. The pending deadline for providers to update their code sets to the latest version of the International Classification of Diseases (ICD) standards is looming, he says. Under federal law, all providers and payers are mandated to upgrade to the ICD 10 code sets by Oct. 1, 2013.

So what are the options for providers searching for a revenue cycle solution? While there are stand-alone, best-of-breed offerings, the market is dominated by revenue cycle management modules that come integrated with larger financial software offerings from vendors such as Siemens or McKesson. Gardiner says the tight integration found in these all-in-one systems appeals to providers, which often include revenue cycle management upgrades in broader I.T. infrastructure revamps.

Pauline Putman, chief financial officer of Bridge Community Health Clinic in Wausau, Wis., opted for an integrated revenue cycle solution when the provider updated its technology stack in the fall of 2009. The revenue cycle management module Putman chose came in tandem with practice management and electronic medical record solutions from Alpharetta, Ga.-based HealthPort. The module is designed to link remittance and denial management to the claims process and helps providers manage their interactions with payers.

Putman says the functionality in the revenue cycle module was important, noting the software contains a reporting tool designed to help community health centers meet federal and state quarterly reporting requirements. "What I was looking for was something that could help me monitor the revenue and make sure that all charges we're being accounted for," she says.

With three locations throughout Wisconsin, Bridge Community Clinic is a federally funded community health center serving over 21,000 under- and un-insured patients each year. The fact that Bridge Community provides general medical, dental and mental health service also factored in the decision to purchase an integrated clinical documentation and financial management system, she says. "We provide quite an array of services so we needed something that can support all of them."

Speeding the flow of revenue was also a prime consideration for choosing to adopt revenue cycle management software, she adds. "We want to receive our money in a fair amount of time, preferably 30 days."

The paperless nature of the revenue cycle module also appealed to Putman. She wanted the ability to correct small discrepancies in billing or coding-an appeal over a $10 underpayment in a claim, for example-without resorting to paper. "We also wanted a system that would allow us to follow up with insurance companies electronically," she says, noting that some systems that promise paperless transaction fall short.