Top RCM So­lu­tion Providers

Providers turn to au­to­ma­tion as pres­sures mount to im­prove billing and pay­ment col­lec­tion pro­cesses.

Health Data Management - - CONTENTS - BY DIANA MANOS

As pay­ment pro­cesses be­come more com­plex, most health­care providers rely on more than one rev­enue cy­cle man­age­ment so­lu­tion. Here’s a look at some of the top RCM ven­dors.

Im­prov­ing the rev­enue cy­cle con­tin­ues to be a chal­lenge for health­care or­ga­ni­za­tions, as pres­sures mount to ef­fi­ciently col­lect pay­ment for ser­vices. As health­care de­liv­ery con­tin­ues to evolve, provider or­ga­ni­za­tions are con­tin­u­ing to strug­gle in max­i­miz­ing their rev­enue-col­lec­tion op­er­a­tions. That’s where rev­enue cy­cle man­age­ment (RCM) tech­nol­ogy comes in—to at­tempt to au­to­mate the process of re­quest­ing pay­ment. The shift to value-based care, in­creased pa­tient pay and a flurry of merg­ers are cre­at­ing new chal­lenges for health sys­tems, and many or­ga­ni­za­tions are look­ing for ways to im­prove their rev­enue cy­cle op­er­a­tions. The com­plex pay­ment en­vi­ron­ment is caus­ing providers to use mul­ti­ple RCM prod­ucts, ac­cord­ing to a recent sur­vey by HIMSS An­a­lyt­ics, con­ducted in part­ner­ship with Di­men­sional In­sight, a de­vel­oper of an­a­lyt­ics and data man­age­ment solutions. Among the find­ings, 68.9 per­cent of health­care or­ga­ni­za­tions use more than one ven­dor so­lu­tion for RCM. What fol­lows is a list­ing of some of the larger com­pa­nies pro­vid­ing RCM solutions in the health­care mar­ket.

Ad­van­tEdge Health­care Solutions

Ad­van­tagEdge is a med­i­cal billing com­pany that ap­plies its billing ex­pe­ri­ence to aid providers in the devel­op­ment of RCM soft­ware. It serves physi­cian groups, hos­pi­tals, surgery cen­ters and be­hav­ioral health agen­cies, and pro­vides soft­ware solutions for med­i­cal billing, cer­ti­fied cod­ing, an­a­lyt­ics, prac­tice man­age­ment and com­pli­ance.

athenahealth

The com­pany pro­vides scal­able health­care RCM solutions via a cloud-based net­work, with real-time vis­i­bil­ity into rev­enue cy­cle op­er­a­tions. The scope of its tools and ser­vices spans elec­tronic health records, prac­tice man­age­ment and RCM soft­ware, pa­tient en­gage­ment, care co­or­di­na­tion and soft­ware to im­prove pop­u­la­tion health ser­vices.

Change Health­care

Re­branded in 2015 from Emdeon to Change Health­care, the com­pany of­fers tech­nol­ogy solutions for providers that in­clude gov­ern­ment and pri­vate pay­ers, physi­cians, den­tists, phar­ma­cies and lab­o­ra­to­ries. Emdeon Pay­ment Man­ager, an elec­tronic pay­ment and rec­on­cil­i­a­tion so­lu­tion, in­creases vis­i­bil­ity of re­mit­tance data and fa­cil­i­tates elec­tronic trans­fer of funds from the largest payer net­works in the in­dus­try.

Conifer Health Solutions

Conifer pro­vides tech­nol­ogy-en­abled health­care per­for­mance im­prove­ment ser­vices. With more than 30 years of health­care op­er­a­tions man­age­ment ex­pe­ri­ence, it of­fers value-based health­care solutions to en­hance con­sumer en­gage­ment, drive clin­i­cal align­ment, man­age risk and im­prove financial per­for­mance.

Con­ver­gent

Con­ver­gent man­ages busi­ness process out­sourc­ing, rev­enue cy­cle and re­ceiv­ables man­age­ment, with 14 North Amer­i­can op­er­at­ing cen­ters across all four time zones. The com­pany has more than 60 years’ his­tory serv­ing a di­verse in­dus­try cus­tomer base, in­clud­ing con­tact cen­ter solutions, re­ceiv­ables man­age­ment out­sourc­ing, com­mer­cial re­ceiv­ables man­age­ment and health­care RCM.

Drchrono

A provider of EHRs, prac­tice man­age­ment and RCM tools, Drchrono’s plat­form is built for iPad, iPhone and Ap­ple Watch. Last year, it part­nered with TriZetto Provider Solutions, a tech­nol­ogy com­pany that helps health­care prac­tices sim­plify busi­ness pro­cesses and im­prove med­i­cal billing.

Ex­pe­rian Health

The com­pany is a provider of RCM, iden­tity man­age­ment, pa­tient en­gage­ment and care man­age­ment solutions. Ex­pe­rian Health pro­vides ser­vices to some 3,100 hos­pi­tals and health sys­tems and 7,000 other health­care providers.

GE Health­care Part­ners

GE Health­care Part­ners pur­chased billing ad­vi­sory firm the Cam­den Group in 2015, and now pro­vides client prob­lem-based solutions, long-term strate­gic part­ner­ships and ad­vanced an­a­lytic capabilities. It of­fers med­i­cal billing soft­ware and RCM solutions for all types of care set­tings.

Health­care Re­source Group

HRG spe­cial­izes in med­i­cal cost con­tain­ment and fraud man­age­ment solutions. It of­fers in­fra­struc­tures for uti­liza­tion re­view, case man­age­ment, dis­charge plan­ning, clin­i­cal chart au­dit, bill re­view, phar­macy man­age­ment, chronic disease man­age­ment and fraud man­age­ment im­ple­men­ta­tion for use across com­plex health­care sys­tems.

Huron Con­sult­ing Group

Huron Con­sult­ing Group is a global firm that aims to help clients im­prove and sus­tain growth, per­for­mance and lead­er­ship. It pro­vides ex­per­tise in ac­cess to care, pa­tient en­gage­ment, li­a­bil­ity col­lec­tions, de­nials man­age­ment and preven­tion, payer con­tract­ing and strate­gic pric­ing, and clin­i­cal doc­u­men­ta­tion im­prove­ment.

McKes­son

McKes­son pro­vides re­sources, sup­port and tech­nol­ogy to help health­care or­ga­ni­za­tions strengthen their busi­nesses, con­trol costs, de­velop ef­fi­cien­cies and im­prove qual­ity. Its in­ter­op­er­a­ble health IT sys­tems help cus­tomers scale, stream­line and au­to­mate com­plex value-based re­im­burse­ment mod­els such as bun­dled pay­ment. The com­pany of­fers end-to-end RCM solutions.

MedAs­sist

MedAs­sist, which of­fers solutions in eligibility and en­roll­ment, ac­counts re­ceiv­ables and hos­pi­tal busi­ness of­fice man­age­ment, is now partnering with Con­nance, a health­care pre­dic­tive an­a­lyt­ics firm. MedAs­sist will use Con­nance’s AR Man­age­ment Plat­form and De­nial and Un­der­pay­ment An­a­lyt­ics to en­hance its in­sur­ance fol­low-up op­er­a­tions.

MedeA­n­a­lyt­ics

With more than 20 years’ ex­pe­ri­ence in help­ing health­care or­ga­ni­za­tion im­prove clin­i­cal, financial and op­er­a­tional out­comes, MedeA­n­a­lyt­ics of­fers de­ci­sion-mak­ing anal­y­sis via a cloud-based plat­form.

Nex­tGen Health­care

Nex­tGen Health­care’s ser­vices in­clude as­sis­tance in im­prov­ing financial and clin­i­cal per­for­mance, max­i­miz­ing op­por­tu­ni­ties to in­crease rev­enue, cor­rect­ing op­er­a­tional in­ef­fi­cien­cies and el­e­vat­ing out­comes across the rev­enue cy­cle. The com­pany’s team of more than 1,300 billing, claims and prac­tice man­age­ment ex­perts help de­liver full-ser­vice, scal­able, end-to-end RCM solutions.

NueMD

The com­pany of­fers prac­tice man­age­ment med­i­cal billing soft­ware, cloud-based EHR and pa­tient por­tal soft­ware, mo­bile charge cap­ture and med­i­cal billing ser­vice, as well as on-de­mand claim in­for­ma­tion and cus­tom re­ports.

On­tario Sys­tems

On­tario pro­vides soft­ware and solutions to help health­care providers re­cover rev­enue ef­fi­ciently and in com­pli­ance with mar­ket and gov­ern­ment stan­dards. Its Artiva HCx pro­vides ad­vanced data an­a­lyt­ics and prod­uct solutions that stream­line and au­to­mate in­sur­ance and self-pay op­er­a­tions.

Op­tum360

The com­pany’s 7,700 per­for­mance ex­perts pro­vide rev­enue cy­cle lead­er­ship, in­no­va­tion and op­er­a­tional as­sis­tance to help elim­i­nate in­ef­fi­cien­cies in health­care and pre­pare for value-based re­im­burse­ment. Its RCM ex­per­tise in­cludes mar­gin per­for­mance, payer-provider col­lab­o­ra­tion, pa­tient ex­pe­ri­ence, com­pli­ance and trans­parency.

Par­al­lon

Par­al­lon is a rev­enue cy­cle com­pany with more than 15,800 em­ploy­ees serv­ing more than 600 hos­pi­tals and 3,000 physi­cian prac­tices. Its ser­vices in­clude rev­enue cy­cle spe­cialty solutions, eligibility and ad­vo­cacy ser­vices, delin­quent ac­count col­lec­tions and more.

Pa­tientco

Pa­tientco is a pay­ment tech­nol­ogy com­pany that brings to­gether pay­ment in­fra­struc­ture with in­tu­itive con­sumer pay­ment tools backed by an­a­lyt­ics. It of­fers easy-to-use tech­nol­ogy that en­sures that health sys­tems max­i­mize pa­tient pay­ments.

Vizient

Vizient, which ac­quired MedAs­sets in 2016, is a mem­ber-based provider of per­for­mance im­prove­ment plat­forms. It of­fers ad­vi­sory, clin­i­cal, op­er­a­tions, phar­macy and sup­ply chain solutions.

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