Out with the old, in with the new.
What does automated revenue cycle management look like?
In the healthcare revenue cycle space, the adage “Time is money” certainly rings true. Denials, late-charges, re-billings and inaccurate claims are all issues that contribute to delayed and diminished reimbursement. These time-consuming and manual remediation processes are considered compulsory in an industry where margins are so incredibly thin that simply foregoing missed charges and revenue is not an option. What steps can an organization take to reduce these costly and inefficient workflows?
The answer lies in real-time, automated revenue integrity monitoring. Reviewing claims as they are sent out the door, addressing denials weeks after a patients discharge, analyzing months old data trends to identify inconsistent charging are all reactive approaches that drive up AR days and are no longer viable in modern RCM.
Charge adjustments should not take place after coding or a claim submission; at this point it is often too late in the process to catch a missed charge or eventual denial. Comprehensive, up-to-date software analytics need to replace outdated, manual methodologies. Revenue integrity teams need immediate and actionable data to make their corrections well before the critical point where denials or missed charges are thereafter inevitable.
Softek and CPI Experts have developed a software solution to address these revenue cycle challenges. The software is built on a Rules Engine that assesses both clinical and charging data to ensure hospitals are capturing the accurate amount of revenue for the services delivered.
The Rules Engine is unique in the industry due to real-time access to the Cerner® Millennium™ database combined with a library of more than 1,000 strong rules constantly being maintained and updated as industry charging and billing standards evolve. This combination allows for automated crossmatching of the clinical and charging data, across all organizations, workflows, and charging methods at one time, in one tool.
Issues with missing HCPCS/CPT codes, missing charges, incorrect units of services, and coding/compliance are identified in an instant. Running extraction files or reviewing 837 data after the fact is no longer necessary. The ability to comprehensively and coherently aggregate revenue cycle data in real-time results in reduced denials, reduced late charges, decreased rebilling, and more timely and accurate payments.
Retaining legacy processes to address new and changing revenue cycle challenges is no longer an option. New, up-to-date, automated software exists to optimize processes and mitigate these struggles that every healthcare organization faces.
To learn more about this software through a call or demo, please reach out to me at Kyle.Crow@softekinc.com.
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