What is Revenue Cycle Management (RCM) Software?
Healthcare Revenue Cycle Management (RCM) software system is the main basis of hospitals and other healthcare practices. Effective management processes allow medical practices to keep profitability along with dealing with timely claims and payment processes.
The Electronic Health Records software keeps a close look at each patient’s experience, from early scheduling and registration through the visit and finally to post-visit experience and final reckoning. Medical practices implement these systems to automate this important tracking experience. And after doing that, they can spend more time focusing on treating patients and providing better healthcare.
Revenue Cycle Management (RCM) EMR system streamlines complex financial tasks so providers can focus on patient care. From tracking each billable patient appointment to scheduling through to payment completion, all is done using the capabilities of a top Revenue Cycle Management EMR Software.
There are tons of other tools and capabilities within the RCM EHR software system. The software should be able to verify health insurance eligibility while scheduling appointments, creating claims submissions with the correct codes, and patient payment notices and collections. Revenue Cycle Management (RCM) Software helps to boost the patient’s financial experience by streamlining the complete billing process.
Main Features of Revenue Cycle Management (RCM) Software
Not all revenue cycle management (RCM) software offers the same features and capabilities. That is why EMRSystems has created this guide to give you an idea of the must-have features of RCM software. You can make use of this guide to reach out to various electronic health records vendors and access their demos. Before buying a Revenue Cycle Management EMR Software, you should make sure that it has the following key features:
Appointment Scheduling – The RCM EMR software system should be able to record the initial patient outreach and track any scheduled appointments.
Insurance Information – The software must be able to collect patient insurance information and verify its eligibility.
Copayment Validation – The top RCM EHR software should be able to validate the copayment amount covered by insurers and adjust the remainder due accordingly.
Patient Appointment Documentation – The Revenue Cycle Management EMR software must manage the proper code output, based on the type of visit and the services that took place during the patient visit.
Claims Management – The software should be able to maintain an organized database of all current and past claims and accurately send and file bills to keep claims updated.
ICD-10 Compliant – The software must manage the details of ICD-10 cataloging and keep the practice compliant.
Secure Payment Processing – RCM EHR software should securely and reliably be able to accept credit, debit, and other electronic forms of payment.
Denial Management – The best Revenue Cycle Management EMR software must be able to organize denials based on critical signifiers such as the source of denial and reason for denial all through one place.
Key performance indicators and reports– A good revenue cycle management software system generates meaningful financial and managerial reports. The RCM tools also track KPIs.
What You Need To Know About EHR Software
Overview
Electronic Medical Records Software commonly referred to as EMR Software represents the electronic method of storing medical records for patients. Using specially designed software, physicians and other medical professionals can store anything ranging from patient demographics to extensive clinical information about patients, such as medical history, social history, lab reports, and more.
EMR Software by Specialty
Since all medical providers (MDs, DOs, PAs, NPs, LCSW, OT, etc.) work distinctly based on their background and medical specialty, EMR Software or EHR Software must accommodate the unique style and documentation requirements. Examples of such specialty-specific features include the ability to annotate images or the capability to store before/after photos for Pain Management specialists and Dermatology specialists respectively. Similarly, other specialties such as Pediatrics, Oncology, Podiatry, Ophthalmology, Neurology, Nephrology, Dialysis Centers, Rheumatology, and Chiropractic Care require their unique set of specialty-specific features to simplify adoption.
Meaningful-Use
Since the introduction of the HITECH Act, healthcare IT has undergone a massive transition starting from the widely recognized Meaningful Use program to what is now known as MACRA, the Medicare EHR Incentive Program. The Meaningful Use program has transformed and now formed part of the four components of the new Merit-Based Incentive Payment System (MIPS), which itself is a fundamental part of MACRA.
For some medical practices, the transition from paper-based records to EMR Software (Electronic Medical Records Software) has not been a simple one. Regardless, realizing that the benefits of utilizing ONC Certified EMR Software far outweigh the hassle and challenges associated with it – ensuring a viable future, most practices today have successfully transformed their clinical and administrative operations to EMR Software.
EMR Software Benefits
Aside from ensuring tangible financial incentives and profitability, practices converting to EMR / EHR Software have seen the following benefits:
EMR Software Requirements by Practice Size
Just like a medical specialty, EHR Software requirements also depend on the size of the medical practice. From solo-provider clinics to large multi-provider, multi-specialty clinics, every practice has unique inherent challenges that must be addressed by the EMR Software vendor.
Small or Solo Provider Practices
A small doctor’s office not only has a limited number of staff members but their EMR Software budgets are also extremely low compared to a large enterprise such as a hospital. Due to these budgetary constraints, many providers simply choose to employ Free EMR Software or choose an affordable EHR Software vendor with a low fixed monthly fee. Cloud-based access is one such important requirement so that these providers can access patient charts even from home when needed.
Medium-Sized Practices
These practices usually consist of 5 to 10 medical providers often belonging to the same medical specialty. Their requirements are more stringent, and their budget is also considerably large. Aside from specialty-focused requirements (EHR Software by Specialty), these practices also require unique features such as interoperability, dedicated customer support, multi-device support as well and extensive reporting functionality to keep an eye on the overall performance of the practice.
Large Practices
Larger group practices generally comprise more than fifteen or often twenty medical providers. These practices usually provide medical services that fall under various medical specialties (Orthopedics, Pain Management, Surgery, Chiropractic Medicine, Family Medicine, etc.). Therefore, these practices require support for multiple users to access the system simultaneously, as well as for the Scheduling software to accommodate multiple locations, providers, and resources such as Dialysis Chairs, procedure room allocation, etc. These practices also keep replacing or adding staff members and need a scalable EMR software solution.
Hospitals or enterprise organizations
EHR software companies such as Epic, Cerner, Allscripts, NextGen, Athenahealth, IMS by Meditab, eClinicalWorks, Meditech, McKesson, MEDHOST, etc. usually target and provide solutions for larger corporations like Hospitals, ACOs, PCMH, IPAs, CINs (Clinically Integrated Networks), Public Health Departments, etc.
These customers have the most elaborate list of requirements, which are usually documented in the form of an RFI or RFP to assess and shortlist vendors that can meet them. The requirements consist of features like inventory management modules, interface with local labs (LIS), machines, and diagnostic equipment along with drug dispensing (pharmacy management software) and electronic medication administration records (EMAR), etc.
These entities also require the EHR software also need to integrate with multiple other software and medical devices.
Why does your practice need EMR Software?
Since the introduction of Meaningful Use, most healthcare practices simply have little or no choice but to convert their practice operations to EHR software. However, most providers today select the EHR software of their choice that best suits their specific needs and must perform an extensive search to evaluate all available options before they find one that is suitable. Most potential EMR Software buyers in the market today have the following in common:
- Do not know what they are looking for
- Know exactly what they want but don’t know where to start or find it
- Relying on advice from colleagues using EMR software already
Although #3 is ideal, every provider and practice workflow is unique and therefore what works for one provider may not suit the other. “One size fits all” simply doesn’t apply in the world of healthcare IT. Software experts and industry specialists are an ideal source of information, and advice and ultimately ensure that the right decision is made.
What to Look For in a Potential EMR Software?
EMR software includes several types of software based on specific applications or functionalities:
Cloud-based EMR software
Small doctor offices benefit the most from Cloud-based EMR Software technology since minimum to no upfront cost or maintenance is required and accessing the EHR Software is possible from any location given the availability of internet access. This type of EMR software is also device independent in most cases and can be accessed using devices such as Smartphones (Android & iOS), iPhones, iPads, laptops, and desktop computers.
Mac EMR Software
Apple dominates the digital device and computers market in the US today, so it is no surprise that many providers are specifically looking for their EHR Software vendor to support Mac operating system (Mac EMR Software). Not all Vendors today work on a Mac device, so looking for a vendor with native support for Mac devices is essential to ensure that the software performs on existing hardware at the practice and does not require more investment in computer systems.
ONC-ATCB Certified EMR Software Vendors
This is the most significant requirement for most software buyers today as the software must comply with the standards and guidelines set by the Office of the National Coordinator (ONC). Online repository details all software vendors and details related to their respective compliance with the measures set by the ONC-ATCB (Click here). Software that complies with these standards have undergone rigorous testing and confirmed at a benchmark level defined by the federal body. The software testing done during this exercise checks all areas of the EMR Software system from Patient Portal access to the way the EHR Software communicates with other programs and entities like labs, Pharmacies (via e-Rx), hospitals, HIEs, etc.
Revenue Cycle Management EMR software
Electronic health records software (EHR) for certain specialties such as Cardiology and Vascular Surgery must provide unique tools to document the clinical workflow of those specialists such as specifying the area of concern. Pain Management specialists, for example, must be able to specify joint pain through a method more than mere capture of text data.
Integrated Practice Management Software
With competition rising in healthcare IT, EMR software providing integrated Practice Management software as part of their overall software package easily outperform rivals with standalone EHR Software including those that may provide a specialty-specific EHR software. EMR Software companies with integrated Practice Management solutions often tend to provide extensive reporting capabilities to track practice performance and manage the business operations better.
Integrated Medical Billing Software
Medical practice has several needs of software systems to streamline operations across the board. One such important area is billing for services rendered and communications with insurance companies. Medical Billing Software, therefore, works best when integrated with the Electronic Health Records (EHR) software. All clinical documentation seamlessly conforms to the required standard and forms a financial document that can be electronically sent to payers (insurance carriers) to verify and process at their end. This simplifies the operations and ensures all parties are on the same page when it comes to the financial health of the enterprise. Medical billing software helps practices and medical billing managers generate claims, patient statements, verify patient eligibility and more. This software is ideal for practices who want to handle billing in-house and can integrate with EMRs.
Security
An EMR Software must ensure the security and safety of patient records while ensuring privacy and HIPAA compliance for patient/doctor communication (Patient Portal). This is a paramount concern for physicians and HIPAA compliance should be guaranteed at all times by the EHR Vendor. Most Vendors today (Epic, Cerner, Athenahealth, AdvancedMD, PrognoCIS, Modernizing Medicine, eClincalWorks etc.) are aware of the importance of HIPAA compliance and have taken steps to ensure the safety of patient records security in every section of the EHR Software using advanced tools like data encryption technologies to enhance the security of the EMR software.
Kareo Clinical EMR Software
Specific Services
One of the decisions your practice will have to make is whether you want just an EMR software or one with an integrated Practice Management for billing and scheduling. There are advantages to having both together but there have been cases where some practices only go for one if they had unique requirements that a vendor could not fulfill, or they had already paid a hefty amount for a PM software and weren’t looking to replace it yet.
Ease of Use and Training
Doctors are not IT professionals, and though some might be tech-savvy, it would be egregious to expect them all to be experts on the EHR software. Ease of use is essential to make the transition from paper to electronic smooth, as well as day to day practice to go along without a hitch. If the software is too complicated and hard to understand, it’s a waste of precious time and needlessly aggravating. Some vendors offer free training while others don’t; make sure you ask for training if your practice needs it.
Specialty Specific
Not all specialties are created equal, so why must their software be generic? Basic EHR software works well and good for general practice and most specialties, but doctors have complained about specialty specific not being available in the market. The specialty software’s have inbuilt recording systems that make specialty practices functioned efficiently. Only a few vendors provide specialty-specific software, so there aren’t many to choose from. But the more vendors are cottoning on to the demand and there should be more options in the near future.
Support
Support is a major issue most practices have with their current vendors. A good support team can make small glitches to major roadblocks easy to maneuver while a bad one will just make things worse. Some vendors provide support as part of the plan you’re already paying for, while others charge extra for support. Scout the market, read reviews or just ask point-blank if there will be a special support team assigned to each practitioner and whether you’ll be charged for the service.
Mobility
Smartphones have changed the dynamics of mobile usage. Handheld devices are easy to carry around and can be used for any number of uses. Most people are ditching the cumbersome PC for a handheld device. Doctors mostly use iPads or Tablets in the examination room to take down patient symptoms, check history and note down the prescription, so it’s imperative that the vendor has a mobile application that is synced with all the mobile devices being used in the practice.
Hidden Cost
There are varying price lists out there, some offer free services, while others charge an arm and a leg for specialty services. Either way there will be hidden costs that you might get to know about later. Fix your budget and talk to vendors you interview about hidden costs within the contract and whether services such as training and support are free.
Practice Fusion EMR Software
Market Trends to Be Aware Of
Like anything else, the EMR software industry is also subject to constant changes. From new technology to legalities and governing bodies, everything is constantly changing. Here are some of the changes I think it would do well for you to keep track of.
Cloud-Based Services
It’s no surprise that more vendors are switching to Cloud-Based EMR software. Cloud-Based EMR software systems can cut down on steep upfront costs that otherwise would be spent on client servers, and they can even be hosted from any device with an internet connection and web browser, making them a much more convenient option. Research has found that only 25% of practitioners are interested in a web-based EMR system, whilst 50% are willing to have it as an initial model that eventually transitions to cloud-based.
Meaningful Use Changes
At a healthcare conference Andy Slavitt, the administrator of the Centers for Medicare & Medicaid Services declared that Meaningful Use was over. Since then Meaningful Use has been renamed Promoting Interoperability and has brought along new updates to its core principles.
The program has been overhauled, with the CMS dedicating the program to the exchange of health information and patient data as well as encouraging medical professionals to implement Certified Electronic Health Records (EHR) technology.
Real-time Analytics
Medical practices and healthcare facilities generate huge amounts of patient data. This data aids clinicians and medical practitioners in clinical decisions (CDS) and by utilizing analytic algorithms, interoperability-related accessibility issues can also be solved. The development of data warehouses can also provide an opportunity to ensure the accuracy of patient information due to automation.
Accessibility
The EHR software industry is quickly widening its range of practice types to become accessible to a wider range of healthcare services. The number of people who lack the time and knowledge in health IT is increasing each year. This makes optimizing these EMR software solutions more difficult as they must now cater to different needs. Douglas W. Bowerman, MD, predicts we will see a “continued trend towards accessibility” in Electronic Health Records software, both in terms of how we access them – on mobile, for instance – and who can access the EHR software.
Changing Dynamics
Electronic Health Records (EHR) Software is constantly influenced by developments in technology. A common example is the recent addition of AI Virtual Assistants to EMR software systems, being able to assist practitioners with daily tasks and increase practice efficiency. With industry leaders such as Apple and Google looking to enter the healthcare space, more competition can be expected between Electronic Medical Records software vendors. This will likely lead to the rapid modernization of EHR solutions and large-scale updates.
Standardization
Currently, Electronic Medical Records software systems are regulated by standards that are very lax. Due to this, some Electronic Health Records software vendors have had to pay millions of dollars in settlement fees, regarding false claims about meaningful use certifications. Regulations, for electronic medical records, are becoming far more strict and more transparent, to prevent such incidents in the future. Medical billing coders will likely use separate interfaces from physicians as they both require unrelated data, so sharing the same regulations would likely lead to life-threatening miscommunication.
5G
5G networking is set to become a standard of data communication technologies in the next few years. 5G may not be able to completely integrate with health IT software, despite even offering up to 100 times the speed of ordinary 4G networks. There are still many different mediums of data transfer all of which are already competing to standardize EMR software communication. Due to this, many Electronic Health Records software solutions use different communication methods, making them incompatible and unable to communicate with each other. Therefore, despite its promises, 5G networks will be unable to get past this bottleneck until there is an agreed standard.
Block-chain
Most notably used in cryptocurrency and NFTs, blockchain technology has recently found use in Electronic Medical Records software systems. The technology uses cryptography to secure medical record data, ensuring that it can only be viewed by someone with given access. This could even be used for validating information such as clinical trials, claim results, tracking medicine distribution, and can prevent insurance fraud. Starting from early 2022, blockchain technology has already been implemented to secure data and keep confidentiality.
Better Patient Access
Whilst better patient access is expected of many EHR software systems, the feature has not been completely integrated yet. According to a study in 2019, only 10% of patients (who had access to their records) viewed them. Additionally, of these patients, 63% were encouraged to do so by their respective providers. Vendors of electronic medical records software (EMR software) are updating their systems to be easier to navigate and to better suit patients’ requirements; this also prepares EMR systems for potential future regulatory changes. More health practices are also providing more guidance and raising awareness to encourage more patients to regularly check their health records before appointments.
EHR Footprint
It is crucial for Electronic Health Records software systems to be inclusive of a wide range of digital capabilities. By working towards better data liquidity, data would be more accessible and therefore increase the EHR footprint – which can be done without compromising on security. Additionally implementing interoperable electronic health record systems (EHR systems) would also allow better access and exchange of patient information between healthcare organizations.
Digital Therapeutics
Digital therapeutic software uses different methods to help treat patients and medical conditions. Its typically used via mobile devices (i.e. smartphones and tablets) and is beginning to integrate into Electronic Medical Records software systems and become more patient-centric. The popularity of digital therapeutics can only be expected to rise as they start to meet industry requirements and clinical trials continue to be published.
Reducing Errors
Whilst many electronic medical records software systems facilitate better accuracy and efficiency, human error is not completely irradicated. Error prevention is something that is not currently addressed properly in EMR and EHR software. In previous years, it was common to blame handwriting for inaccurate paper prescriptions – however even with computers, relying too much on them can be dangerous. In one instance, a 16-year-old patient was prescribed 38 tablets of medicine (in 2013), which resulted in an overdose. Currently, Electronic Medical Records (EMR) Software developers are developing solutions, such as decluttering physician notification centers to allow more time to be spent with patients and reduce distractions.
Searchability
Presently with Electronic Health Records software systems, being able to easily process large amounts of data can prove to be quite a hassle. Current generations of EMR systems still seem behind and dated in terms of UI and ease of use. However, this is beginning to change as more EMR vendors have begun providing updated UI in their EHR software solutions to better facilitate easier data access to electronic health records.
Wearable Devices
Wearable devices have been surging in popularity in the medical industry, with the market still expected to grow by 26.8% from 2022 to 2028. By improving the accessibility of healthcare metrics (for both patients and practitioners), diagnosis has become much more simplified. Additionally, by integrating this data with Electronic Medical Records (EMR) software systems, there is the potential to innovate patient healthcare and health IT solutions. The technology is currently compatible with specialized health apps on mobile phones, smartwatches, and fitness trackers.
Patient-Centric Engagement
The growth of your practice can be benefited greatly by boosting patient engagement. One approach can be to make resources and content readily available within patient communities. Another can be to increase patient outreach. Additionally, regular appointment reminders (which can be handled via appointment reminder EMR software) can reduce cancellations and improve patient engagement.
Easy Access
Patients require quick, easy, and secure access to their data so that they can be engaged and informed in their healthcare. The Electronic Medical Records (EMR) software industry is evolving with the latest health IT technology to improve on these points, which will help patients to build better trust with their providers. It is likely that this trend will continue, for greater health outcomes.
Widespread Interoperability
There’s a lack of data-sharing standards across EMR software systems, which stops patient information from being shared across different practices. This can lead to problems in diagnosis (for patients who visit various centers) and even for the patients themselves. To solve this, EHR vendors are adding more updates to their software to make Electronic Medical Records software more interoperable. and to include more integrations to allow such data to be shared more efficiently.
Patient Portal
There are many benefits to a patient portal EMR system. They remove the need for paperwork and manual fetching of data, and they offer a direct portal for patients to view their medical records. By allowing easy access to their records, patient portals also encourage patients to be more involved in their healthcare, which also enables easier diagnosis for medical practitioners.
Artificial Intelligence
Artificial intelligence and machine learning have both had major impacts on health IT in recent years. It is likely that as these continue to evolve and change, they will have just as big of an impact on EMR software systems. AI and machine learning algorithms can improve Electronic Health Records software by making them more intuitive and efficient, they can help streamline medical workflows and can help improve patient outcomes. Applying these technologies to EHR software systems can also enable physicians to provide much more personalized and proactive care, by identifying any potential health issues early through analysis of patient data. By providing access and insights into large amounts of patient data, artificial intelligence, and machine learning algorithms have the potential to revolutionize clinical research and drug development.
Latest News on Revenue Cycle Management Software
Revenue Cycle Management Company FIRM RCM Acquired by Aspirion
Aspirion, a healthcare Revenue Cycle Management (RCM) provider, has announced its acquisition of FIRM Revenue Cycle Management, Inc. (FIRM RCM), a company that helps recover denied, unpaid, and underpaid medical insurance claims for hospitals.
Chairman of the Board of Aspirion, Richard Thomas, stated that “the combination of Aspirion and FIRM RCM demonstrates Aspirion’s commitment to investing in high-growth companies positioned to address the increasingly complex financial challenges of the US healthcare system”.
