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Revenue Cycle Management Excellence

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Success Starts with a Strong Revenue Cycle

Across the entire healthcare technology landscape, patient care remains the top priority for hospitals and health systems—of all sizes. But to ensure the breadth and depth of care delivery can continue to expand, a strong foundation is required, and revenue cycle excellence is the key to driving outcomes across the board. The simple truth is that healthcare is a business, and healthcare organizations face the challenge of bolstering their revenue cycle outcomes every day. However, there are solutions to help deliver the care patients need while maintaining a healthy bottom line. Staying in the black all depends on how well organizations can manage their revenue cycle.  

Healthcare revenue cycle management is constantly evolving. Organizations around the world are finding it difficult to keep up with changing reimbursement models while also combatting shrinking operating margins. In the pursuit of new revenue sources, the reliance on artificial intelligence (AI) and other logic solutions within the electronic health record (EHR) can only complement advice on optimizing revenue cycle management (as well as EHR systems as a whole). But there is more to the story.  

To keep up with the changing demands, and to strengthen your organization’s financial foundation, there are a few tactics that will drive success. First, it is time to get granular. The revenue cycle comprises of many steps, and while keeping an eye on the “bigger picture” is also necessary, optimizing every piece of the revenue cycle process is imperative. Getting a close look at each step will help magnify challenging areas and illuminate opportunities for improvement. Also, staying attuned to the healthcare industry’s thought leaders’ guidance on where to focus your time and energy, common challenges faced, and changes seen across other organizations’ revenue cycles can highlight additional areas for optimization. As an industry leader, Altera Digital Health, a healthcare software company, has the revenue cycle management technology, as well as the deep expertise, to help organizations harness best practices and maximize every part of the revenue cycle process. A strong focus on optimization today will enable better outcomes across your entire community for years to come.


Diving deep into the revenue cycle management process

As organizations turn their focus toward revenue cycle management to enhance their overall healthcare technology investment, examining each step in the revenue cycle process is a critical piece of transforming their bottom lines. Altera experts have outlined detailed avenues organizations should take to reap the benefits of a healthy revenue cycle. 

Integrated Patient Scheduling

This order-to-scheduling integration helps drive more comprehensive and effective communication between clinicians, office staff members, and patients. It also ensures that all follow-up information is captured in a single database, which promotes streamlined financial and operational efficiencies. With this enacted, organizations will see a lower cost in collecting reimbursements.

Embedded Financial Clearance

Enabling this offers more detailed verification and eligibility assistance and assurance while also providing early notice of out-of-pocket payments due. Organizations that remain diligent with this step will often have a higher insurance verification rate, leading directly to more timely payments.

Embedded Charge Capture

This provides easily adaptable charge capture rules and automated charge capture for acute and ambulatory settings. With it, organizations can ensure the correct charges are consistently recorded for the services a patient receives, even as the hospital’s rules change. The benefit of this is a lower cost for collecting as well as a reduced number of charge lag days.

Enhanced Claims Submission

With this, organizations are armed with an embedded scrubber with a robust library of pre-claim edits—nearly 29,000. For best success, an EHR platform should also be built from the ground up for episode-based billing. This can be done using a highly automated process to create bundled claims for services received across multiple facilities with minimal manual intervention. The benefit seen by most organizations focusing on this step is a lower denial rate, increased clean claim rate, and higher cash collection as a percent of patient revenue.

Integrated Payment Collection

This step supports organizations in combining in a timely manner, which enables higher cash collection from patients and payers at a quicker pace.

Integrated Denial Management

When this step is optimized, through features such as dynamic work queues that are configurable to hospitals’ needs, it enables quick identification of recurring problems that lead to denials while also lowering net A/R days.

Robust, Real-time Reporting

Focusing on this step will provide staff members the ability to review financial reports and proactively identify areas of improvement. If done well, this will lead to an overall better financial performance.

All of this might seem a daunting task, but you don’t have to do it alone. Altera experts and thought leaders are ready to provide thorough guidance on how you can achieve the best possible revenue cycle outcomes. We have experience in helping organizations drive revenue cycle management excellence and the revenue cycle management solutions that can maximize collections and bolster your bottom line.


Top revenue cycle management concerns for financial leaders

Understanding the full revenue cycle and how each step can be optimized is a great starting point, but a few critical areas remain top of mind for healthcare financial leaders.  

Many people think revenue cycle management in healthcare means medical billing services. However, revenue cycle directors and chief financial officers know the revenue cycle is a multi-step, complex process that starts before the patient experience even begins.

An effective revenue cycle management strategy is foundational to the financial viability of a healthcare organization. By extension, revenue cycle management is also a major determinant in an organization’s ability to provide high-quality healthcare. 

Today’s healthcare financial leaders have many moving parts to keep track of, but a few elements remain top of mind. 

Cash on hand and cost to operate
Days cash on hand and
cost to operate
Improving financial metrics
Sustaining a satisfied
virtual workforce
Sustaining a satisfiedvirtual workforce
financial metrics

Days cash on hand and cost to operate

Days cash on hand is one of the primary indicators of an organization’s financial status. This number denotes how many days an organization can pay its operating expenses using the total amount of available cash. It is common for organizations to aim for 60–90 days cash on hand.  

Cost to operate, or the operating margin, is another significant metric for healthcare CFOs. This number is the difference between the total cost of running the organization and the revenue it captures. If the days cash on hand decreases, the CFO must find a way to lower costs to maintain a consistent operating margin. 

To meet financial goals Gartner® recommend organizations begin by implementing solutions that digitize core revenue cycle processes. Healthcare technology that ensures the accuracy and completeness of data collected at the very beginning of the revenue cycle is a great place to start. When high-quality data from patient registration and scheduling is integrated with downstream RCM functions, payments are processed more easily so organizations are reimbursed more quickly. 

Organizations farther in their digital transformation journeys should maximize the foundational technology already in place and elevate it with Altera Revenue Cycle services. For example, many organizations do not completely map claim-adjustment reason codes and remittance-advice remark codes—but they could enhance these processes with the right revenue cycle management technology. Sunrise™ Financial Manager has extensive, in-depth configuration to not only map all denials but also handle exceptions and move balances forward to the next responsible party. This increases cashflow and streamlines the secondary billing process.

Three phases of RCM Digitalization
Healthcare Provider CIOs’ Top Tips for Revenue Cycle Management Optimization, Refreshed 3 March 2021, 5 September 2019, By Sachin Dev. GARTNER is a registered trademark and service mark of Gartner, Inc. and/or its affiliates in the U.S. and internationally and is used herein with permission. All rights reserved.

Sustaining a satisfied virtual workforce

Since the beginning of the COVID-19 pandemic, a substantial percentage of administrative and financial staff members have been working remotely. This trend has created new challenges for managers at healthcare organizations, such as maintaining staff productivity. Additionally, the labor market has become incredibly competitive due to the number of staff resignations. As a result, it has become even harder to hire revenue cycle talent with the right experience.  

Solutions like Sunrise Financial Manager offer flexibility to easily transition to new business and payer models remotely, reducing COVID-19 challenges. Additionally, further enhancing technology with ongoing monitoring and services, like those delivered through the Altera Revenue Cycle Center of Excellence, enables productivity tracking for onsite and remote employees with dashboard metrics. 

Leveraging artificial intelligence and robotic process automation—the third phase of Gartner RCMS optimization pathway—is another way to boost the effectiveness of today’s workforce. These solutions help offload mundane tasks from people so they can focus on more complex, valuable work.  

Consider the notice of admissions (NOAs) process. Payers have stringent timeframes in which provider organizations must send NOAs. Failure to meet these requirements often results in denials that are difficult to appeal. Automating the NOA process can help healthcare delivery organizations ensure they receive appropriate payment for services rendered without holding overburdened staff members to strict deadlines.

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Improving financial metrics

Given the fluid nature of the healthcare industry, healthcare delivery organizations must remain flexible to absorb new payer models and receive reimbursements for services rendered. Additionally, they must navigate new and shifting business models.  

To make informed decisions amid these changes, healthcare organizations should look to RCM software that enables them to get granular insights on various contracts and methods of payment. The Sunrise portfolio of solutions offers analytics solutions and dashboards, based on HFMA best-practice standards, that provide visibility into the financial strength of individual programs and service lines. Leveraging this data, decision-makers can determine strategic next steps to maximize profitability. 

Learn how Sunrise solutions and services can support your organization’s revenue cycle management.

Optimizing your Revenue Cycle Management

The value of partnership in healthcare technology

Revenue cycle management can be a difficult space to navigate alone. It’s important to have a trustworthy partner with the expertise and support to help guide your end-to-end revenue cycle and improve financial performance.   

The Altera Revenue Cycle Center of Excellence (RCCoE) is a collaborative and cross-functional service that provides a consultive approach to success in revenue cycle management. Paired with Sunrise revenue cycle management solutions, our experts at the RCCoE review your data to identify current trends against benchmarks and help improve your revenue cycle.  

After their analysis, our experts conduct one-on-one conversations with organizations to ensure an in-depth understanding of their findings and to discuss plans for improvement moving forward. As plans are implemented, our innovative dashboards enable our experts to monitor progress on a monthly (or even daily) basis. If negative trends begin to emerge, conversations between our experts and our partners take place to understand the root cause and identify potential solutions based on industry best practices.  

With consistent monitoring and the knowledge of revenue cycle experts, your organization can optimize the revenue cycle and improve your business.

Enhancing performance with artificial intelligence and bot technology:

As you continue to build improvements in your revenue cycle management outcomes, you innately want to look to what comes next. As healthcare technology progresses, the role of artificial intelligence (AI) and bot technology in revenue cycle management will become increasingly important to the conversation of a “better bottom line.” Currently, much of the conversation about AI focuses on clinical use cases, and its ability to improve patient care and diagnoses. But there are many applications for AI beyond the clinical space. Using AI in the “back office” can have profound and lasting effects on an organization’s revenue cycle management processes.  

AI can predict and identify trends, which makes it invaluable to the revenue cycle management process. This includes the capacity to learn and recognize what each insurance provider is willing to cover. With this capability, AI eliminates the need to submit all claims to all payers to see what gets approved. Instead, AI submits claims directly to the party responsible for paying, enabling organizations to spend less time on denials and receive payment faster than ever.  

Beyond the ability to learn trends, AI is also able to automate most aspects of revenue cycle management. By automating routine cases, your staff will be able to focus on special cases that require human intervention. With more time dedicated to the cases that need it, revenue cycle automation through AI leads to faster resolutions and faster payments to your organization. 

With AI and bot technology, your organization can increase cash flow and create a more efficient staffand this is just the beginning. To stay competitive in the healthcare space, it’s vital to understand the benefits of implementing this revenue cycle management software into your organization’s process.

Revenue cycle management success

From Springhill Medical Center to Wise Health Systems, Altera clients of all shapes and sizes are maximizing their revenue opportunities. Optimizing the revenue cycle from end-to-end with our healthcare solutions and services is not only possible—it's been done. 

Springhill Medical Center integrates clinicals and financials, strengthens its revenue cycle 

Springhill Medical Center is a privately-owned, full-service hospital serving southwest Alabama. Executive leadership determined that integrating clinical and financial systems would enable the organization to remain agile and deliver a better patient experience.  

“When it comes to health IT, our CEO Jeff St. Clair sees the big picture,” said Delanea Radbourne, Senior Manager of Managed IT Services at Springhill. “He understands the value of having an integrated clinical and financial platform…He knew that to be ready for the future, we’d need to combine them onto a single platform.” 

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A Sunrise™ client since 2004, the medical center and Altera developers built Sunrise™ Financial Manager to achieve full revenue cycle functionality, including revenue capture and medical billing services and receivables management, and the teams focus on continual adaptation to new reimbursement models. 

Sunrise Financial Manager automates financial transactions and offers streamlined workflows to assist with error correction for more accurate information. “We’re getting claims out the door and expect to see our speed increase,” said Radbourne. The solution also aggregates clinical outcomes, revenue, cost and reimbursement data.  

Since the implementation, Sunrise Financial Manager has enabled Springhill leaders to make more informed operational decisions that have a noticeable impact. For example, the organization aimed to have less than 20% of Accounts Receivable (A/R) at more than 90 days. With Sunrise Financial Manager, A/R over 90 days decreased to 14.3%. Additionally, the medical center set out to have less than 45 net days in A/R, and with Financial Manager, net days in A/R capped out at 38.

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Wise Health System creates integrated patient record with Sunrise 

Wise Health System is a comprehensive network of specialized services and offerings working together to meet their region’s current and future healthcare needs. Serving patients in 13 counties, Wise Heath System offers a full suite of services from Bariatric Surgery to Wound Care. 

Wise Health System implemented Sunrise™ Financial Manager in 2019 for both their acute and ambulatory services. With Sunrise Financial Manager and their other Sunrise EHR solutions, Wise was able to create a full platform of health experience that supports holistic and fully integrated patient records. Physicians who split their time between seeing patients in the hospital and ambulatory offices can properly document all procedures performed, regardless of location.  


“Our physicians are incredibly busy,” said Lynn Giddens-Branscum, Vice President of Revenue Cycle and Audits at Wise. “They had to document procedures performed at the hospital before they went back to the clinic for the rest of the day. If they didn’t have a good system in place to communicate what they did at the hospital, they’re going to miss a lot of notes and charges. With that in mind, we put processes in place so that we’re capturing all the revenue and billing for it.” 

Sunrise Financial Manager also enables Wise to quickly mine data, generate reports, and identify trends – all in a system flexible enough to quickly implement changes as needed. “It has provided us with the agility to respond to various circumstances, most recently the COVID-19 pandemic,” said Giddens-Branscum.  

With healthcare technology like Sunrise and Sunrise Financial Manager, you can improve outcomes for patients, the quality of life for providers and the effectiveness of medical billing services. 

One patient, one record, complete data
Established a system to capture financial data in 14 days
Improved documentation, captured missed revenue
reduce costs
Reduced costs, promoted a healthier environment

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