Revenue Cycle Management Software

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Buyers Guide

Last Updated: November 22, 2022

Health care revenue cycle management is the central foundation of hospitals and all other health care practices. Successful management processes enable medical practices to maintain profitability while dealing with timely claims and payment processes.

These health care systems monitor the entirety of each patient experience, from initial scheduling and registration through the visit and finally to post-visit statuses and final retribution. Medical practices adopt these systems to offload and automate this tedious tracking endeavor. And in doing so, they are able to spend more time focusing on treating patients and providing great experiences.

But not all revenue cycle management (RCM) software is created equally. That's why we've created this guide to give you an idea of what the must-have capabilities are. Use this as a jumping off point for reaching out to vendors and doing some demos. From there, you'll be able to make the best selection for your unique needs.

In this guide, we'll cover:

What Is Revenue Cycle Management Software?

As we explained before, revenue cycle management software is the financial workhorse of medical practices, tracking each billable patient interaction from scheduling through to payment completion.

That sounds easy enough, but there's a ton of tools and capabilities within RCM software. They include the ability to verify insurance eligibility when scheduling appointments, creating claims submissions with the most correct codes and patient payment notice and collection.

Revenue cycle management software operates along all points of the patient/billing journey, including:

Typical Revenue Management Cycle for Medical Practices

Typical Revenue Management Cycle for Medical Practices

Given its operational importance and breadth of functionality, choosing the best RCM software for your unique needs is all the more critical.


Common Features of Revenue Cycle Management Software

Revenue cycle management software provides users with the tools necessary to manage all stages of the medical practice. Key features include:

Scheduling and registration Record the initial outreach and track any scheduled appointments.
Insurance verification/validation Gather patient insurance information and verify its eligibility.
Copay management Validate the copayment amount covered by insurers and adjust the remainder owed accordingly.
Patient visit documentation Manage the proper code output based on the type of visit and the services that took place during the visit.
Claim management Maintain an organized database of current and past claims. Accurately send and file bills and keep claims updated.
ICD-10 compliance Manage the intricacies of ICD-10 cataloging and keep your practice compliant.
Payment processing Securely and reliably accept credit, debit and other electronic forms of payment.
Denial management Organize denials based on critical signifiers such as source of denial and reason for denial.
Accounts receivable Keep track and provide a filterable snapshot of the money still owed to your medical practice.
Patient statements Send detailed statements to patients highlighting what's still owed, what insurance has covered and available payment methods.

What Type of Buyer Are You?

Moving from paper to automated systems. These buyers want to automate their medical processes, cutting back on paper-based organization and unnecessary exposure to human error. These buyers want to improve office efficiency and provide a more consistent patient experience.

Replacing legacy systems. These buyers have gotten everything they can out of their current system, and it's become a hinderance to their operational efficiency. Regardless of whether they have a mixed together system, something built in-house or just old software, they need greater reliability, federal compliance and more transparency into the financial well-being of the practice.

Centralizing capabilities into one RCM system. These buyers come from practices that have pieced together disparate applications to get what they need. This approach might work for a while, but it very likely will begin to impede growth, as it makes it difficult to scale operations. Moving to a single RCM system enables practices to have a clear view of the status of the organization and also drill down to see critical information at the patient level.

Benefits of Adopting Revenue Cycle Management Software

There are different benefits that revenue cycle management software offers based on what you're replacing. However, there are also similar benefits shared by all new RCM adopters. These include:

Increased operational efficiency. Revenue cycle management systems enable health care practices of all types and sizes to define optimized processes for managing each step in the revenue cycle. These processes and newfound automations are certain to increase operational efficiencies for users.

Maintain financial health. Easily track and explore critical financial metrics to gauge the financial health of the organization. Drill down to see specific components of the payment process that might be stalling final retribution.

Ensure federal compliance. Lean on an ICD-10 coding catalog to not only ensure medical codes are compliant but also give time to employees who would otherwise be inundated with coding edits.

Market Trends to Understand in Revenue Cycle Management

Mobile. More and more medical practices are leveraging mobile technologies such as smartphones, tablets and wearable devices to improve operations. We're increasingly seeing medical vendors providing support for patient information access as well as payment processing on mobile.

Cloud-based software. Cloud-based revenue cycle management software gives providers and patients the ability to easily (but still securely) access patient data, billing and payment statuses from any compatible device with internet access. Cloud-based RCM platforms most often operate on a subscription basis, making them more affordable for smaller practices looking to get a new system in place.

Patient portals. Mobile, SaaS and other digitalization in the health care space isn't reserved for providers. Patients now expect communications and access to their medical information through online and mobile portals. If that's something you're interested in, take a look at our guide on patient portal software.