Issue link: https://beckershealthcare.uberflip.com/i/1092388
64 Executive Briefing The solution: An integrated RCM platform While the initial rise in high-deductible health plans and patient out-of-pocket spending increased the demand for niche solutions to support a better billing experience from patient check-in through payment collection, the usefulness of disparate RCM solutions is diminishing. Now, organizations are looking for solutions to the inefficiencies these tools created. "In a bolt-on scenario, you would have to pass that balance to a third-party product, and that balance sometimes gets lost or is wrong," Mr. Law said. "Worse still, you're involving the patient in what is potentially an inconsistent or incorrect balance. It can create a lot of problems in that balance transfer and interaction with the patient. If you have a truly integrated solution, balances get passed correctly onto the patient." End-to-end RCM solutions and technologies that leverage coding, charge creation, electronic data interchange, payment posting, accounts receivable follow-up and interactions can now integrate critical and more granular RCM processes that were previously bolted on. A more consistent and secure billing process for patients can be created when providers replace each coding, eligibility check, pre-certification and clinical documentation add-on with a single streamlined and integrated RCM solution. Under an integrated system, providers know when an accurate bill is sent to the patient. They can track the entire payment cycle. As a result, accurate data is consistently entered into the revenue cycle system. What providers once considered in-house, back-end functions that required different vendors for different processes can now be consolidated into a fully integrated RCM process that begins before patient registration and ends with patient follow-up and collections. Exceed patients' financial expectations with the right RCM solution The advantage of having an integrated RCM system lies in providers' ability to conduct consistent, clear and tailored payment dialogues between patients. "When an RCM solution owns the whole patient interaction from start to finish, providers can start to look for trends and patterns in patient wants and needs," said Sean Vyain, principal enterprise architect at Zotec Partners. Zotec Partners provides this integrated service for independent medical groups, hospitals and health systems. Currently, Zotec manages more than 80 million medical encounters and serves approximately 15,000 physicians nationwide. Zotec's proprietary technology helps automate the process of managing claims. When a physician treats a patient and enters corresponding billing codes, Zotec bypasses third-party bolt- on technologies like clearinghouses and goes directly to the insurance provider. A clearinghouse is a public or private entity, like a billing service or a community health information system, that processes nonstandard claims and transactions from a provider into standard data for payers, or vice versa. "Zotec makes sure claims go directly to the payers and are accepted. The direct filing of the claims to the insurance plans is definitely advantageous to relying on multiple third-party vendors," Mr. Law said. In addition to back-end services, Zotec also acts as a one- stop shop for front-end RCM services. For example, when a patient goes to the front desk and asks for the estimated amount they will be responsible for before receiving medical attention, Zotec's technologies can help providers answer these questions without having to rely on an additional outside vendor. Back-end and front-end services are thus integrated, which also means all metrics can be viewed on a single dashboard. "Leading providers are focused on owning that patient financial interaction from end to end," Mr. Vyain said. Why it matters: To the patient, RCM equals patient experience The evidence is clear: Patients are the fastest growing payer. Collectively, patient healthcare costs, including both deductibles and out-of-pocket maximum payments, have climbed 30 percent since 2015, according to a 2017 Black Book report. This trend shows no sign of slowing. As RCM processes like registration, preauthorization and billing are oftentimes the main point of patient contact for providers, the onus is on providers to deliver a financial experience that measures up to patient's expectations. It's these processes that linger in patients' memory and influence their future medical decisions. Consequently, to modernize and streamline RCM, healthcare leaders should consider dropping bolt-on solutions and upgrading their patient financial operations to a single integrated, automated RCM solution. "This is a consumer-oriented business now," Mr. Vyain said. "Patients are advancing their technological expectations, and healthcare executives have to keep up and stay ahead of them." n Zotec Partners is an industry leader in revenue cycle and practice management services for physicians and health systems, managing in excess of 80 million medical encounters annually. The company is committed to the continual pursuit of excellence, delivering effective solutions through its proprietary technology, personalized service and measurable client results. Currently, Zotec Partners serves more than 15,000 physicians in all 50 states.