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What Is RCM Software?

Revenue cycle management (RCM) software combines the financial and administrative sides of medical practice to simplify the processes in which patients get billed and services get paid for.

RCM software automates administrative tasks, pulls data from healthcare IT management solutions, and organizes various financial processes, such as invoicing and receiving.

RCM functionality is often found within comprehensive software solutions, such as electronic health records software (EHR) and electronic medical records (EMR) software. However, as standalone software, it’s imperative for RCM to integrate with other software solutions.

Read more: Healthcare Trends Private Practices Need to Watch

Top Revenue Cycle Management Vendors

athenaIDX no yes yes no no
CareCloud no no yes no no
DrChrono no no no no yes
Kareo no yes no yes yes
Waystar yes no no yes no
Product AI Automation Integration Charge Capture Mobile

athenaIDX

Athenahealth is a healthcare IT solutions company that provides cloud-based practice management and EHR systems. athenaIDX Revenue Cycle Management is one of many scalable solutions that it offers to healthcare practices of all sizes.

Key features include:

  • Authorization management
  • Charge entry and coding
  • Claim denials resolution
  • Claim scrub, issue resolution, and submission
  • Insurance verification and coverage scanning
  • Patient refund issuing
  • Performance reporting and insights
  • Posting and payments
  • Registration verification and co-pay collection
  • Zero pay and insurance credit resolution

Add-on services, such as athena EDI, enhance what athena IDX can do by proactively addressing payor issues, thereby speeding up your practice’s revenue cycle.

athenaIDX is scalable; however, for small practices seeking revenue cycle support, athenaCollector may be a better option.

CareCloud

CareCloud is a cloud-based software provider for the healthcare industry. Their Revenue Cycle Management solution is flexible, meaning your practice doesn’t have to commit to CareCloud’s entire practice management/EHR platform if it doesn’t want to. It integrates with many other popular software solutions. Even as a standalone product, CareCloud’s RCM has a lot to offer. This includes:

  • Analytics
  • Billing for out-of-network services
  • Benefits verification
  • Charge entry
  • Claim denial, submission, and error detection
  • Compliance
  • Patient billing
  • Payment posting
  • Specialized billing, remittance, and collection support

A couple of standout features of CareCloud’s RCM is that it ensures that your practice stays up-to-date on regulatory changes, such as MACRA or ICD-10. Moreover, it handles worker’s compensation claims and payors, an area of specialization that we haven’t seen with other vendors.

DrChrono

DrChrono is an EHR and medical billing platform that manages patient intake, clinical charting, billing, and revenue cycle management. DrChrono’s RCM product ensures that your practice has a steady income stream so you can focus on patient care.

Here’s what you get with DrChrono’s RCM:

  • Billing services with a team of billing experts
  • Claim denial analysis and resolution
  • Coding review and audit with the help of in-house coding compliance officers
  • Continuous claim monitoring
  • Dedicated RCM account manager
  • Electronic remittance advice (ERA)
  • Medical billing with the help of certified medical coders
  • Patient collections
  • Reporting via business intelligence tools

DrChrono’s business intelligence tool is a feature worth noting, as it provides medical practices with real-time reports and insights into how to improve practice performance. This is especially helpful for small practices and/or those that are relatively young.

Kareo

Kareo is a cloud-based electronic health record solution and revenue cycle management provider that specializes in serving independent practices. Its medical billing product focuses on automation and workflow so you can concentrate on the services you provide to patients, rather than the behind-the-scenes work of billing and payments.

Features of Kareo include, but are not limited to:

  • Billing analytics
  • Billing tasks
  • Claim tracking
  • Nationwide billing rules engine
  • Point-of-care capture of charges
  • Scheduling and calendar functionality

Managed Billing Smart Workflow is a feature in Kareo’s RCM that encompasses automated tasks and workflows for patient intake, scheduling, check-in, billing tasks, billing analytics, claim tracking, and more. Kareo also features analytics to track KPIs, monitor trends, and identify opportunities for improvement. 

Kareo is a great option if you’re looking for a comprehensive platform. 

Waystar

Waystar is a cloud-based platform that serves healthcare providers in financial and operational aspects by centralizing their payment processes in one place. Its suite of AI-powered solutions include:

  • Analytics and reporting
  • Claim management
  • Denial prevention and recovery
  • Payment management
  • Revenue capture

The revenue capture branch of their platform contains three different solutions: Charge integrity, DRG Anomaly Detection, and Transfer DRG.

Like Kareo, Waystar is an integrated platform of solutions. The functions of Waystar’s platform, including its revenue capture function, are not available as a la carte options. However, Waystar offers bundles, so if your practice is looking for at least a few different revenue management tasks to defer to software, Waystar likely offers a solution package that fits your needs.

Must-Have RCM Features

Automation

The more repetitive tasks that your RCM of choice can take over for human staff, the better. RCMs should automatically keep information flowing throughout the revenue cycle from patient visit to payment received. 

Data Analytics and Reporting

The payment process should be visible and intuitive to those who manage the practice and its financial operations, which means the RCM should also have dashboards and reports. Vendors commonly offer a reporting function that identifies places for improvement in the way your practice handles a number of stages in the revenue cycle process, such as coding, billing, receiving, etc. 

Integrations

Some RCMs are available for purchase as isolated products without needing to commit to an entire platform. In that case, it’s imperative that the RCM of choice integrates with your practice’s existing EHR/EMR solutions to avoid interruptions in workflows.

Benefits of RCM

More Revenue

RCMs maximize your practice’s revenue by ensuring clean (error-free) claim submission, uncovering lost revenue from underpayment, and collecting claims payments more quickly via automation. And with the help of AI tools, intelligent RCMs track KPIs for your practice and alert you to your practice’s performance from a financial perspective.

Efficiency Through Automation

Medical and administrative staff at your healthcare practice can focus on what software can’t — customer service and quality patient care — if they’re not held up by manual data entry. Today’s RCMs take care of identifying code errors and underpayments, sending invoices, and more.

Accuracy

Coding errors are often a result of poorly trained staff or simple mistakes, but they can cost your practice a lot of money. Choose an RCM that automatically identifies medical coding errors and/or has a robust support team of expert coders who can assist your staff in ensuring billing accuracy.

Choosing the Right RCM

The right RCM for your practice hinges on whether you have solutions currently in place that you’re satisfied with. In that case, you’ll want an RCM solution from a provider that offers it as standalone software. However, be sure the RCM will integrate with the software already in use.

Otherwise, if you need an overhaul or have the budget to commit to a platform, it’s more cost-effective to opt for a vendor that offers a comprehensive suite of solutions.

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