Providing a Digital Workforce for Revenue Cycle Optimization

In today’s value-based healthcare environment, there are gaps that inhibit hospitals and health systems from efficiently managing the revenue cycle. Information often lives in disparate data silos like patient kiosks, the EHR, legacy practice management systems, payor websites, and clearinghouses that may not communicate well, or even at all. Better management of the claims process is necessary. Whether it’s claims denials, re-submissions, prior authorizations, eligibility, or Medicare billing, we’ve seen it and solved it, with decades of experience optimizing revenue cycle management.

By utilizing an automated process, a virtual digital SWAT team drives efficiency and boosts bottom line revenue. Automation merges data from competing system silos, ensures there are no duplicates, gaps, or missing information, and corrects issues like incomplete claims data before the claim ever hits the queue. If a data element is missing, we access the payor site, log in, capture, and correct the claim, then update the information in the billing system, all without the administrative data burden associated with claims management. This “closes the loop” in billing, and #bridgethegaps in interoperability.

Value-based reimbursements, unlike the traditional fee-for-service model, are driven by data. Providers must report to payers on specific metrics and demonstrate improvement. This is a challenge for the hospital and health system when data resides in multiple systems because it’s difficult to capture, collect, and compare. Complexities often arise, and these require hours or even days of staff time. Automation steps in and performs the heavy lifting, easily and efficiently, with no staff burden and 100% accuracy.

Studies confirm, up to 65% of claim denials are never re-submitted, because, according to the MGMA, “the average cost to rework a claim is $25.00.” Automated processes allow a claim denial strategy to be implemented seamlessly, correcting and resubmitting denied claims without an increase in people or process. The beauty about this process is the ease with which it works to effectively optimize trends, identify gaps, find missing charges, and correct information without the need for a human touch. Working 24/7/365, healthcare automation allows organizations to re-allocate “people” resources to higher priority tasks.

In a recent CFO survey conducted by Black Book, 92% of survey respondents believe the CFO of the future must do a better job leveraging technology and staff with IT skills for health providers to succeed financially. Automation is a great place to start, as it provides a measurable and fast ROI. It’s easy to implement, usually within 30 days, and the impact is tied directly to dollars in the door.

Work smarter, not harder. Minimize variations and take away the complexity out of claims management. Automation reduces decision-making and improves the workflow, speeds days in A/R, and increases revenue almost instantly. By automating revenue cycle management tasks you can significantly streamline and advance financial processes, allowing people to focus on what’s at the heart of their jobs – advancing patient care.

Why Boston Software Systems?
Boston Software Systems’ experience has been ensuring automation projects remain on track since 1985. Working across a wide-range of vendors and applications, we are experts on streamlining workflows, reducing costs, and improving usability for hospitals, health systems, provider organizations, and technology partners. We have worked with all of the leading EHR vendors, optimizing usability and role-based user satisfaction.

With over 95% of our healthcare automation projects being completed in under 30 days, savings are right around the corner: 866-653-5105

Attending #HIMSS20 or feeling a bit of #FOMO? You can be a change-maker and learn more about #RCM best practice guidelines by downloading our whitepaper. Or signing up for a 30-minute call to discover how you can optimize revenue cycle management, with the use of automation.

#ReThinkRCM #smartHIT #DigitalHealth

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