Revenue Cycle Management Software

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Buyers Guide

Last updated: June 04, 2023

A Revenue cycle management (RCM) system is one of the core foundations of hospitals or medical practice. Its purpose is to help healthcare providers maintain optimal profitability along with ensuring timely claims submission and quick payment processes.

These software are designed to monitor each activity during the patient experience, from the initial registration till the final retribution. Most medical practices implement RCM to automate most tracking and monitoring workflows. This provides practitioners with the freedom of focusing more on their patients rather than repetitive administrative tasks.

Much like many things in this world, not all RCM are created equal. That’s why we’ve created this guide to help you identify top-performing RCM systems. In this guide, we’ll talk about all of the factors you need to understand revenue cycle management systems. Here’s what we’ll be discussing in this buyer’s guide:

What is a Revenue Cycle Management?
Revenue Cycle Management Features
Choosing a Revenue Cycle Management Vendor
Revenue Cycle Management Benefits

What is a Revenue Cycle Management?

A revenue cycle management is used to streamline billing processes, track and monitor patient experience, get faster payments, and ensure compliance with healthcare regulatory bodies. You can choose to implement this system as a stand-alone service or as an integrated part of your electronic health records (EHR) software. The reason it’s such a unique software is that it reduces redundant steps and streamlines billing tasks that are otherwise prone to errors.

In other words, an RCM system is the financial infrastructure of medical practices and hospitals that tracks each patient’s visit and interactions from initial scheduling to the final payment.

Although that may sound like an easy process, it comes with a lot of tools and features. This includes insurance eligibility of patients during appointment scheduling, creating insurance claims, accurate coding, and documentation.

A revenue cycle management system is divided into five categories:

Pre-visit: This step involves tracking patient registration and validating insurance eligibility.

Medical Exam: This step involves processing upfront co-payment and provides services.

Generating Payment: Track, monitor, and bill patients for the procedures and facilities used.

Payment Collection: Process claims with the right documentation and sends them to the patient and the insurance companies.

Cycle Management: Monitor financial performance and ensure the financial health of your practice.

There are hundreds of revenue cycle management systems in the market today. They range from providing the mere basic services to a full-fledged revenue cycle management that caters to all of your billing needs. All of which are designed to simplify the manual billing processes and create ease for practitioners.

Here, I’ll be going over the various features of revenue cycle management along with the requirements of selecting your software vendor for your practice.

A successful revenue cycle management implementation offers numerous benefits to your practice. For instance, these benefits include reduced costs of administrative tasks, minimized chances of error, enhance patient satisfaction, and improved clinical efficiency.

Here’s all you need to know to make the most of your revenue cycle management.

Revenue Cycle Management Features

Here are some features of revenue cycle management that help improve patient care, streamline your clinical workflows, and simplify administrative tasks.

Patient Intake and Registration – You can also have patients upload all of their personal information, medical history, and billing information prior to their appointment to reduce patient waiting time and increase patient satisfaction.

E-Eligibility Verification – Rather than spending hours and resources in trying to verifying eligibility or services, your revenue cycle management should be able to streamline this task.

Copay Management: Track and validate the upfront copayment amount to be accurate from the insurance companies and adjust the remainder in the claims.

E-Submissions – Your revenue cycle management should offer electronic submissions (or e-submissions). This includes submitting claims to your payers.

Denied Claims Analysis – It’s important to understand why your claims got rejected in the first place. Your revenue cycle management should be able to provide insights into the problems and errors you face when submitting claims.

ICD-10 and CPT Codes – In order to process accurately coded claims, your revenue cycle management needs to be adept in ICD-10 and CPT codes.

Accounts Receivables – Your RCM system should be able to keep track of all the money still owed to your medical practice in a single sheet.

HIPAA Compliance – A Server-based EHR software also needs to ensure patient information confidentiality and privacy through compliance with the Health Insurance Portability and Accountability Act (HIPAA) guidelines.

Choosing a Revenue Cycle Management Vendor

Now that we’ve discussed the necessary features of revenue cycle management, let’s talk about some of the requirements you’d need from your vendor. These may differ for each individual medical practice.

Vendor Size – What type of practices does your vendor typically cater to? Some vendors only provide services to small-scale practices, while others cater to large-scale practices. Therefore, if you have a small practice, paying for services that help large practices, won’t do much good. Similarly, large practices won’t be able to function with services designed for small practices.

Design – The design of revenue cycle management’s infrastructure depends on your choice. Whether you would prefer a cloud-based, web-based, or even standalone software.

Web-based: These companies focus on a web-based approach and practitioners can access their patient information through their web browser.

Stand-alone: Although not quite popular as the others, this software is an on-premise module that can be accessed remotely through smartphones, iPads, etc. as long as you’re connected to your practice’s network.

Cloud-based: Companies that provide native cloud-based software offer you access to patient information through a cloud-storage.

Certification – Vendor certification ensures patient information confidentiality and security and is perhaps one of the most important things to look for in an RCM vendor. So make sure your vendor has ONC-authorized testing and certification body (ONC-ATCB) certification.

Most EMR vendors focus on providing cloud-based RCM services to enhance security and provide seamless services.

Revenue Cycle Management Benefits

Here are some of the most advantageous benefits of revenue cycle management.

  • Improve clinical efficiency.
  • Enhance profitability by lowering costs.
  • Seamless insurance claims management and denied claims.
  • Improve administrative efficiency by simplifying processes.
  • Improve revenue and ROI.