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Enhancing the Abilities of Healthcare SectorRevenue cycle management or RCM solutions for healthcare providers are software platforms for carrying out activities associated with billing and payments at medical organizations. RCM software for providers includes features to handle medical coding, claims, and payment processing. It is integrated with other health platforms like electronic health records and practice management solutions to enable an organization to streamline all operations surrounding revenues. Software solutions for health revenue cycle management allow providers to consolidate all the billing activities for services right from appointment to discharge and final payment.
This is one of the first things that happens on the providers’ side when a patient walks into a clinic or hospital. The staff verifies if the patient’s health plan can cover the services that would be prescribed and to what extent. OSP can build a platform for revenue cycle management for healthcare providers with a feature to verify insurance plans rapidly. This will clearly show the amount provided as coverage and the amount paid as out-of-pocket charges by the patients.
This application for provider revenue cycle management reduces wait times for patients and eliminates the possibility of verification errors. Manual verification might lead to mistakes that deny providers reimbursement, unlike a software solution that leverages healthcare automation.
Sending claims to payers is how providers earn reimbursements, which form the major portion of revenues. But it is common for errors in claims, which result in denials or rejections by the insurance company. In light of this, OSP can design and develop a healthcare revenue cycle management platform that checks each claim before it’s sent to payers. This solution would assess the claims and highlight points where there might be discrepancies, which can later be checked manually by staffers. Claim errors are among the biggest reasons for the loss of reimbursements for providers. But our solution can minimize errors and ensure that all the claims sent comply with payers’ policies.
Denial of reimbursements can cost both time and revenue for providers. There can be numerous reasons why insurance claims get denied, after which providers have to follow cumbersome processes to handle them. But OSP can build HIPAA-compliant solutions for managing the healthcare revenue cycle, which can assess denied claims rapidly. This feature would harness healthcare analytics solutions for identifying patterns among denied claims. By knowing the problems that cause payers to deny claims, providers can address them for future prevention.
Whether it is the revenue cycle of a healthcare practice or a hospital, our solution will help streamline the workflows around claims submissions. In other words, it will boost the efficiency of provider revenue cycle management.
The revenue cycle in healthcare is composed of reimbursements as well as out-of-pocket payments, among others. OSP can build RCM software for providers to have detailed reports on the status and composition of their revenue cycles. In other words, this platform will offer a comprehensive dashboard that administrators can use to view everything related to revenues, like accounts receivables, reimbursements, out-of-pocket payments, and so forth. It would also help determine which payers reimburse the fastest, deny the most, etc.
These insights will help in taking measures to address inefficiencies in medical billing and revenue cycle management. Healthcare interoperability and seamless electronic data exchange amongst all the medical solutions ensures that the reports reflect accurate operational data.
A cloud-hosted software solution prevents it from being installed on computers kept on-premises and also avoids the need for a dedicated IT infrastructure. OSP is a leading revenue cycle management software provider that can help healthcare organizations adopt cloud computing in healthcare. We can build a cloud-based revenue cycle management solution that can be accessed from any computer through the internet. This will be especially helpful for small practices and clinics since they won’t have to spend on dedicated hardware.
Cloud availability makes it an ideal choice for use with integrated healthcare solutions since multiple providers would collaborate across the care continuum. Furthermore, using custom medical informatics solutions to find patterns in claims and reimbursements would also shed light on the efficiency of healthcare management.
Medical coding converts medical diagnoses, procedures, and services into an established set of standard alphanumeric codes. It indicates all the billable services rendered to the patients, which are sent to payers in the forms as claims. OSP can design and build provider revenue cycle management software with features for automated medical coding. This will accelerate all the workflows surrounding coding and ensure that there are no errors.
Coding mistakes account for a large portion of denied and rejected claims. Since our solution minimizes human intervention, it will minimize denials and rejections. As a result, it becomes an excellent tool for optimizing healthcare revenue cycle management.
Software for healthcare provider revenue cycle management helps to consolidate all the billing and revenue workflows into one interface. As a result, all pen and paper-based activities are digitized, making them faster and more accurate. This means that a relatively smaller staff can do more with little to no errors. So, practices, clinics, and hospitals can experience greater productivity with fewer resources, reducing overhead.
Mistakes in coding and claims are the most common reasons for denials and rejections by payers. But the provider revenue cycle management that OSP can build would digitize and automate large parts of the workflows around coding and claims. As a result, there are very few errors, which directly lead to few denials. Moreover, the few denials that may still happen can be analyzed using this software to address problems.
Verifying claims and getting pre-authorizations can result in long wait times for patients. Not only is this an inconvenience, but it also affects patients’ health in case of the ones who need urgent procedures. But software for healthcare revenue cycle management reduces these wait times by accelerating pre-approvals and insurance verifications. This goes a long way in improving the experience for patients.
We’ve reached out and found companies like OSP to create our technology. This is my first time working with a company that has been so thorough. These guys are amazing. If you really are looking for someone for a technology solution, these guys are the real deal.
-- Stephen Carter
We reached out to OSP to provide an estimate on a technology solution we were interested in developing. From the initial conversation, the team was professional, courteous, and thorough. We were able to make a quick decision to move forward with OSP because we were confident that our requirements were accurately captured and the development deliverables and associated costs were clear.
The OSP development team stayed on schedule and within budget throughout the build phase and provided weekly communications to keep our team informed along the way. If we require application development in the future, OSP will be the first call we make.
-- Selita Jansen
We have worked closely with OSP for two years, meeting twice a week to work through development requirements, strategy, design, progress, and support. OSP has become an integral part of our business, and our mutual teams work together as one team. OSP tackles problems that arise with integrity and operate with respect for budgeting.
-- Charlie Langdon
Yes, I would certainly recommend their services because they were diligent and the offered price was very reasonable which is a challenge these days to get a great product at excellent pricing.
-- Bert Lurch
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We built a custom medical billing, credentialing, practice management suite.
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Revenue cycle management (RCM) is all the activities in tracking the entire series of processes involved in patient care. It helps providers to bill for their services appropriately and earn revenues.
RCM allows providers to identify problems in their revenue streams and fix them, allowing for steady income streams. This allows them to keep serving patients efficiently.
Medical billing is a highly complex process. It begins with patient registration and progresses with eligibility verification, coding, charge capture, and claims submissions. A good provider revenue cycle management solution streamlines all the activities mentioned above with digitization. Such software solutions also automate many activities involved in the RCM process. This minimizes or eliminates human errors and accelerates the whole process, resulting in higher productivity and greater revenues.
Patient Registration
This is the first step in the entire lifecycle of medical RCM. It involves collecting patients’ demographic insurance information.
Insurance Verification
This step ensures that the patient’s insurance coverage before offering medical services. It is crucial for avoiding claim denials
Claims Submission
A claim includes all the medical services coded per established standards to be submitted to payers for reimbursements.
Denial Management
Claims might be denied for any number of reasons. Denial management handles denials and also ensures that it never happens again.
Payment Collections
This is the process of collecting payments from patients and insurance payers.
Technology solutions for provider revenue cycle process digitize the whole lifecycle of RCM. Moreover, automation eliminates the need for human operators to carry out manual, repetitive activities. As a result, these tasks are accelerated and immune to human errors. Automation eliminates or minimizes the chances of mistakes and also speeds up processes significantly.
With or without automation, software for revenue cycle management (RCM) provides one interface for all activities. The staff need not enter the necessary data manually since the solution lets them fetch it and enter it with some clicks. This is how the software streamlines the entire RCM process.
Automation
Automation using artificial intelligence and machine learning are the hottest trends in healthcare, especially RCM. These technologies automate repetitive manual, rules-based processes. Doing so frees up time for the staff to do other things and lowers overhead. Lower overhead and increased speed maximize productivity.
Value-Based Care
This is a major topic of deliberation among clinicians and policymakers for healthcare. It aims to lower the costs of care by prioritizing outcomes for patients.
Patient-Centric Approach
This approach to RCM focuses mainly on the patients rather than the providers or payers.
Data Analytics-Driven Operations
Business intelligence garnered from data analytics provides insights about reasons for claim denials, payment delays, reimbursements, etc. This allows hospitals to make informed decisions about relevant workflows.
Electronic health records contain all patients’ medical, demographic, and insurance information. By integrating an EHR with an RCM platform, the data entry and documentation part of the process is streamlined. Things like pre-authorization are done rapidly and automatically with an EHR. Since pre-authorization errors account for roughly a quarter of all claim denials, EHR integration optimizes the whole RCM process.
In addition to fast pre-authorization, things like coding and claims processes are also fast and mostly automatic. This is because the necessary data is obtained from health records with a few clicks and used for the relevant RCM activities. This proves that EHR implementation and integration with RCM solutions boost overall revenues.
Advantages
Disadvantages
The processes around revenues in healthcare are complicated by nature. There are too many steps that open up too many chances of errors. Starting from verifying patients’ health plans to charge capture, coding, and claims generation, coupled with denial management. So, errors or inefficiencies in any one step translate into lost revenues. This is where provider revenue cycle management solutions become necessary.
Provider revenue cycle management solutions streamline all the activities in the RCM lifecycle. Moreover, these software platforms also automate many processes, increasing their speed and minimizing human errors. As a result, individual providers at private practices and even hospitals can have a highly optimized revenue cycle with significantly lower overhead.
The results of a good revenue cycle management process include fewer claim denials, faster insurance verification, rapid and error-free coding, better denial management, and so on. All of these only result in higher revenues for healthcare organizations.
