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Is Revenue Cycle Management Software Really Worth It?

State-of-the art, cloud-based Revenue Cycle Management is a significant investment, so the owner of a Medical Billing Company must ask themselves whether it is worth the cost.

The answer? Only if you want your business to succeed.

Over the last several weeks, we’ve talked about the changes occurring in the medical billing sector, the threats from competitors, and the threats from inefficiencies inside your business. Those are the very reasons the savviest medical billing companies are moving away from traditional systems to adopt end-to-end, cloud-based systems, but even they are sometimes surprised at the tremendous benefits they reap:

Reduced labor costs.
With a cloud-based system, any biller can work for you easily and efficiently, regardless of location. This opens up your labor pool, allowing you to hire talented billers from places where the cost of living is less. You may even decide to use offshore billers. Plus, a sophisticated system means the automation of manual processes so fewer billers can do the same amount of work with less error.

Increased efficiency.
It begins with a substantial reduction in rekeying—no need to re-enter patient demographics, retype insurance information, or manually check eligibility because this is all done within the system on the front end by the practice’s front office staff. It continues with the ability to ascertain patient responsibility before the visit, leading to more accurate point-of-care payments, less post-visit billing, fewer collections, and most happily—reduced A/R.

Deeper relationships with your clients.
Increased automation, quick access of data by all, and instant communication with office staff lead to a major shift in your role: less bookkeeper, more CFO. Rather than chasing claim errors and battling insurance payers, you are helping your clients enhance operational efficiency, plug revenue leaks, shorten their revenue cycle, and achieve financial best practices for a better bottom line.

A better solution to HIPAA.
There are high-end desktop/server billing systems out there, and while they can get close to the types of efficiencies we’ve been discussing with expensive Intranets and admin-intensive VPNs, locally stored PHI can never achieve the levels of HIPAA compliance that are achieved automatically with cloud computing. Just about every week, there’s a news story on a data breach involving patient information from a stolen laptop or thumb drive. A cloud-based system instantly puts you and your practices into data-compliance with the latest security mandates for both financial and patient data.

Let’s say these benefits are enough to get you looking at cloud-based systems. Here is a list of questions you should ask any billing software vendor you speak to:

  1. Will your software enable me to be profitable at 3.9% or 2.9% of collected revenue? (These are the rates that the behemoth national companies are offering and operating at profitably. A top quality system with have sophisticated Revenue Cycle Management features that allow you to compete on an equal footing with the Athena’s and eClinicalWork’s of the world.)
  2. Does your software offer single sign-on, and global claim management? (The ability to login once and manage all accounts, and then work all claims or denials from a single window.)
  3. Does your software offer drill-down denial management? (While working a denial, can you click and instantly drill down into the information you need, or do you have to navigate to new windows, or run multiple reports before calling your insurances?)
  4. Does your program provide proactive RCM notifications? (Allowing me to be aware of claim, collection, and revenue issues before they arise, instead finding out after there’s a problem and reacting to it.)
  5. Does it have strong claim validation capabilities? (Press for a number. Claim first-pass rates should be in the high nineties.)
  6. Does it have dashboard financial reporting? (All financials on a single screen with the ability to drill down into problem areas, and also reconcile from a single screen.)
  7. Does it have consolidated reporting? (The ability to run reports across groups of practices; and the ability to produce the specific RCM reports you need to run your business.)
  8. Is there sophisticated Practice Management reporting? (To help office managers identify areas of process improvement, uncollected cash, employee theft, unbilled patient visits, and worker time-card productivity monitoring.)
  9. How well does it handle complex billing scenarios? (When you have hundreds of medical practices to bill for, you’re faced with complex billing situations. How flexible is the system in handling complicated and complex billing scenarios?)

As a RCM business owner, you know your business better than anyone, and through the years you’ve evaluated many billing systems, but finding a vendor that answers a resounding “yes” to the questions above is definitely a good place to start.

Overview of PracticeSuite Medical Billing Software

1 thought on “Is Revenue Cycle Management Software Really Worth It?”

  1. I\’m thinking about getting revenue cycle management software, but am a little worried about making sure that it is the best software. I appreciate the tip to look into how well it handles complex billing scenarios.


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