Traditional RCM solutions act as a bridge between administrative and clinical documentation functions but can often perform suboptimally in achieving high revenue integrity across workflows and silos leading to costly billing errors, misalignment with value-based goals, and financial burdens on the organization (and its patients).
Goals and Objectives
Identify new opportunities to reduce the amount of time between providing a service and receiving payment. Enhance revenue integrity by effectively capturing and bridging clinical with financial data across workflows and silos. Automate tasks, production of analytics, and generation of insights that positively impact reimbursements. Facilitate patient’s understanding of coverage, costs, and responsibilities.
- Technologies listed above (under “Revenue Cycle Management”)
- Clinical documentation improvement (CDI), Computer-assisted coding (CAC), Computer-assisted physician documentation (CAPD)
- Big data, AI, and RPA to further drive automation and intelligence for correct coding and reimbursement processes
Use Case Summary
Next-generation revenue cycle goes beyond ensuring end-to-end alignment of clinical and financial functions but ties in the alignment of value-based goals toward maximizing reimbursements, increasing revenue, minimizing denials, and better serving patients.