Revenue cycle management (RCM) can no longer start at the back office or after a patient gets seen. The resulting delay in acting on revenue optimization and denial prevention misaligns with digital era opportunities and, more importantly, expectations (e.g., cost calculators and prior authorization). Next-generation revenue cycle drives better clinical, operational, and financial integration across the provider service continuum to optimize revenue, minimize denials, and improve experiences.
Goals and Objectives
– Introduce new efficiencies and insight through automation and intelligence of prior authorization, billing, and reimbursement workflows.
– Align provider performance with payer incentives.
– Normalize data and enhance revenue integrity across services and silos.
– Identify new opportunities for value creation between providers, payers, and patients.
– EHR, EHR-RCM integration, and RCM software
– Charge capture, coding, claims processing and submission engines, integrated payer rules, clearinghouse interfaces, and electronic remittance and payment posting (with RPA-enabled automation)
– CDI, CAC, and CAPD
– RCM-specific dashboards and reporting (e.g., discharged not final billed, and days in accounts receivable [AR])
– Patient access and front-end optimization (e.g., portals, websites, mobile applications, provider search, and open access scheduling)
– Patient financial engagement capabilities (e.g., AI algorithms on propensity to pay)
Use Case Summary
Next-generation (nontraditional) RCM technologies and capabilities digitally transform the revenue cycle by holistically and intelligently enabling automated revenue optimization and denial prevention across the provider service continuum in alignment with value-based outcomes.