Revenue Cycle Management Software Buyers Guide
Last updated: December 04, 2023
Revenue Cycle Management Software—Why You Need it and How to Identify a Winning Product
You entered the health care industry to help patients, but that’s not the only focus, right. Whether you’re part of a practice, a hospital or a clinic, you need to run a profitable business too. It’s the only way you’ll be able to keep providing your vital services. And the business aspect of health care is no simple niche.
With many factors at play, such as medical insurance, you need expert help. An ordinary accounting system won’t do. Only a revenue cycle management service specifically designed for the health care industry will suffice.
But even narrowing the field to this group of software products gives you many to consider. We compiled need to know information to help you make the right long term decision for your practice.
Why Do You Need Revenue Cycle Management Software
With so many people passing through your doors it can be quite challenging to keep up to date with everyone’s billing requirements. It’s more complicated than an ordinary business’ billing because of:
- Correspondence with health insurance entities where you need to validate the patient’s insurance.
- Complicated coding systems that need to be followed in order to claim payments successfully.
- The intricacies brought about by bills paid by two role players: Insurance agencies and the patients themselves.
Why waste time trying to manage it manually when software can help you? As a bonus these packages are designed to provide you with management features to help you maintain a profitable practice.
If you want this for your health care establishment, discuss these aspects with potential service providers before signing a contract.
The Characteristics of a Quality Revenue Cycle Management Software
No two products will be exactly the same, but for optimum results you should have these functions at your disposal. In some of these categories there will be different options, so pick the types that will work for you.
It's Appropriate for Your Practice
For any EHR related software, always consider the size of your practice. Some programs are designed for small entities, while others are for hospitals. When you don’t discuss this with the vendor you may pay for features you don’t need.
Mobile is Important
Since you’ll be facilitating payments (see below) and you don’t want someone to navigate away out of frustration. Your Revenue Cycle Management software—if it has a patient portal—should be accessible via any computer and be mobile responsive. This is becoming more and more important: Your patients want to manage their lives via their phones.
Also consider: You’ll enjoy managing aspects of your practice more if you can do it via your cellphone too. Be informed no matter where you are.
Helping You Claim
The claims process is integral to ensuring your practice receives payment for services rendered. Much of the responsibility can be shifted from staff members to a quality RCM software program with automated features:
- Keeping patients’ insurance information on record.
- Verifying their information to ensure successful claims.
- Adding the proper codes (also see below) to claims, relevant to the type of visit.
- Managing denials.
- Allocating correct amounts based on co-pay guidelines.
- Sending bills to patients after integrating the claims’ amounts in their statements.
Tracking Your Patients
The only way you ensure your practice is as financially healthy as possible is by making sure each patient’s bills are settled correctly and timely. That means you need to track their visits and payments from the very first day.
Ideally you need this portal to allow an initial registration process. From then on—along with a scheduling system—you’ll be able to have updated information on each individual.
General Accounting Features
Apart from the unique aspects of medical billing, your Revenue Cycle Management software must still handle accounting activities expertly. Don’t waste time doing it manually, since quality vendors will provide:
- Features to process all forms of payment (Credit card, debit card and transfers) so your books stay up to date. Real time is the preferable option.
- A user friendly interface to help you track accounts receivable. Although the software will do the work for you, your staff must still have easy access to view the current state of someone’s account.
- A statement feature should make it easy to view statements or send them to patients to remind them of due payments.
Make Payments Easy
While an effective billing system makes life easy for you, it pays off to also make life easier for your patients. A Revenue Cycle Management software package can add an online payment option to your practice’s features. For starters, it’s a selling point which may have patients flocking to you from other outdated practices. In addition, you’ll see your payment cycles become shorter, which means patients pay fewer penalties (if applicable) and you save money thanks to proper cash flow.
Correct Coding Integrated
For many of the tasks mentioned above your software will make use of codes. The ICD-10 coding system is an important factor in making health claims today, but you’ll only receive payment from insurers if you use the correct ones. That means an ICD-10 integration (upgraded from ICD-9) is a non-negotiable feature.
Monitor Financial Health
Here’s one of the main reasons this is a worthwhile investment: Thanks to all these functions mentioned above, but also specially designed tracking features you’ll always have information about the financial health of your institution. High-end programs will allow you to drill down to specifics so you also know where the problem lies if you notice your financial position is shifting contrary to your expectations.
The biggest challenge in shopping for software products is aligning your needs and preferences with what the software provides. You don’t want to pay for features you’ll never use, but a too simplistic product won’t give you all the benefits that are possible in today’s technologically advanced world.
Start by making your list of requirements for YOUR practice. Then determine what your software should provide to overcome those challenges and afterward discuss it with vendors.
Soon you’ll enjoy the results.