Managing the revenue cycle in the healthcare industry is a complex process. Revenue cycle management software is one of the most helpful tools to address these difficulties. Many firms are offering customized solutions that cater to the needs of specific organizations.
These entities fall into two primary categories: software and outsourcing. Each approach has its merits that depend on the specific requirements of a primary health care practice.
Revenue Cycle Management Software
These companies include healthcare organizations with the tools to handle their revenue cycle independently. Revenue cycle management facilitates tracking revenue, monitoring cash flow, and minimizing errors by streamlining processes. Some software solutions also assist in complying with regulations such as the ‘No Surprises Act’. It provides accurate patient estimates based on insurance plan data.
Additional features you can find in these software solutions include
- Real-time eligibility verification
- Denial management
- Underpayment detection
- Payer contract analytics
While these tools are valuable, organizations must invest time and effort in learning and utilizing the software effectively.
Revenue Cycle Management Outsourcing
Outsourcing companies offer a service-centric approach to revenue cycle management. These entities take charge of RCM tasks on behalf of healthcare organizations. This can be especially beneficial for practices lacking a robust RCM team or expertise. This way it provides cost-efficient solutions and reduces errors associated with manual processes.
However, outsourcing comes with the trade-off of reduced control and potential friction points like slower turnaround times and security risks. The choice between outsourcing and using software depends on the existing staff, billing code complexity, and the scope of RCM department services.
Best 5 Healthcare Revenue Cycle Management Companies
PwC (PricewaterhouseCoopers)
- PwC is a global professional services firm known for its high-quality services. It offers a range of consulting and advisory services, including revenue cycle management (RCM) consulting for healthcare providers. PwC’s approach to RCM involves identifying inefficiencies, strengthening processes, and following the best practices.
- Their RCM services are designed to optimize the revenue cycle by addressing specific pain points within healthcare organizations. PwC’s expertise extends to streamlining billing and coding processes and improving patient collections. What distinguishes them is their strategic emphasis on leveraging technology and data analytics to enhance overall revenue cycle performance.
- By assisting healthcare organizations in selecting and implementing the right technology solutions, PwC ensures a tailored approach to the distinct needs of each firm. Their commitment to utilizing data analytics helps identify areas for improvement and measure performance. This way it ultimately contributes to improved financial performance and enhanced patient care outcomes.
Guidehouse
- Guidehouse was established in 2018 and became a key player in the consulting services sector. Initially the public sector consulting arm of PwC, Guidehouse has expanded its reach into the commercial sector through strategic acquisitions. The firm offers end-to-end RCM outsourcing along with extended business office solutions and revenue cycle consulting.
- It focuses on both public and private entities, especially in highly regulated industries like healthcare. RCM services by Guidehouse involve various areas, including financial management, business intelligence, enterprise risk management, and IT consulting. Their devotion to minimizing operating costs without compromising care quality is notable.
- Its services extend across patient access, mid-revenue cycle, and patient financial services. Guidehouse also provides revenue cycle capabilities, expertise in electronic health records (EHR), and strategic managed care solutions. It helps primary healthcare providers sidestep the complexities of RCM in a dynamic healthcare industry.
Waystar
- Formed by the integration of Navicure and ZirMed, Waystar simplifies healthcare payments across the revenue cycle. Their solutions include financial clearance and revenue capture aimed at enhancing revenue collection. These solutions ensure transparency in billing and claim management, as well as efficient payment management.
- The company’s commitment to utilizing predictive analytics and machine learning, supported by a team of certified coding experts, sets Waystar apart. Their focus on identifying and correcting errors ensures healthcare organizations can maximize revenue collection and streamline financial processes.
Ensemble Health Partners
- Ensemble Health Partners is a tech-driven company offering concrete solutions for revenue cycle outsourcing. Their services cover patient access, revenue capture, and revenue collection, utilizing advanced technology to prevent errors and improve reimbursement.
- Ensemble Health Partners uses technology to prevent errors and revenue loss by detecting missing charges and coding errors before billing. They audit, educate, and improve processes for efficient account resolution and accurate reimbursements.
Azalea’s RCM
- Azalea Health’s RCM solution is designed to streamline revenue workflows, minimize claims and denials, and provide visibility into practice performance. With a dedicated team of certified billers Azalea Health achieves up to 20% better performance than industry standards.
Azalea Health’s RCM combines technology and expertise, ensuring HIPAA compliance, document management, and a focus on reducing outstanding A/R days.
Let’s Summarize
These five healthcare revenue cycle management companies bring diverse strengths to the table. Each of them offers tailored solutions to meet the unique needs of primary healthcare organizations. It shows how they value technology and integrate IT and data analytics in the ever-changing healthcare industry.
The way out between software and outsourcing for RCM counts on each healthcare firm’s needs and resources.
