Sizing up your RCM software purchase: 6 dimensions to review


Software designed to drive each and every aspect of revenue cycle management toward perfection continues to roll out everyday. Deciding which software is best suited to your particular organization, however, can be difficult.

Today's software must comply with ICD-10 coding, as well as Medicare reimbursement rules and terms set by third-party payers, according to a report on But financial software is never one-size-fits-all. CFOs and revenue cycle management leaders must select the right type software to achieve the results they desire.

For organizations on the verge of purchasing healthcare revenue cycle software, the report outlines six areas they should consider.

1. Process integration. An organization's revenue cycle system should integrate with existing clinical and financial systems across the enterprise. The revenue cycle process is about much more than billing and collections. In fact, these are often final steps in the revenue cycle. Earlier steps in the process, such as registration and patient care, are implemented on the floor. Therefore, it is important for healthcare financial software to integrate into a healthcare organization's existing operational processes, according to the report.

2. Admissions and registration. The front-end revenue cycle staff have a number of responsibilities when a patient comes to the hospital. These include getting the patient's insurance information, verifying the patient's insurance eligibility and also possibly obtaining prior authorization for treatment from a third-party payer or obtaining physician referrals. It is important that an organization's revenue management system is able to capture this data accurately and efficiently to prevent claims denials downstream, according to the report.

3. Charge capture. Goods, such as needles and prescription drugs, are billed as hospital facility charges, while professional charges are those billed by physicians and other clinical providers, according to the report. And revenue management software must be able to tell the difference. Facility charges are billed via claim form UB-04, and professional charges are billed via the CMS-1500 claim form, the report states, adding that revenue software should be able to identify and assign charges to the appropriate form.

4. Chart review and coding. Hospital financial software must adhere to the hospital's coding process, the report notes. And it is critical that all services are coded correctly according to ICD-10 standards, as mistakes in the coding process can lead to overbilling and failed audits, according to the report. A revenue management system should perform presubmission audits to reduce coding mistakes. For example, the software might look for ICD-10 codes that can't be billed together.

5. Charge submission. Hospitals and health systems contantly strive to reduce claim denials and speed third party reimbursement. Denied claims are costly to healthcare organizations because manual reworks drain labor and time resources. Unclean claims are also disruptive to the revenue cycle because the rejection and resubmission process delays reimbursement, affecting a hospital's cash flow. Modern healthcare revenue cycle software is able to help healthcare organizations avoid these problems by assisting with the presubmission review process. According to the report, the aim with such software is to be able to check that a claim meets the provider's requirements for submission and that the claim passes basic error checks.

6. Accounts receivable management. According to the report, healthcare revenue cycle software should automate the accounts receivable process by keeping tabs on accounts receivable and, when necessary, generating patient payment reminders. Additionally, financial software should be able to track and issue reports on long-term trends and department performance, the report notes. Preferably, healthcare revenue cycle software should eliminate data silos and focus on capturing relevant data from throughout the organization to streamline the revenue collection process and avoid costly errors.


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