As technology advances, you should see better results from your revenue cycle solutions provider. How do you know you’re getting your money’s worth? See if you can check the boxes on these 12 must-haves.
- Accurate Eligibility Information: You know how important it is to collect patient payments at the point of service, but that requires access to current eligibility status. Your revenue cycle technology should provide batch and real-time eligibility and insurance benefits information so you can collect upfront and avoid bad debt.
- Smart Claim Edits: A smart technology solution grows with experience, meaning every time a claim is rejected, an edit is incorporated into the database to increase the first-pass rate for all users. Does yours do that? If not, you may be missing out on an opportunity to accelerate cash flow and lower AR days.
- Immediate Response to Electronic Claims Submissions: Your claims solution should do more than submit claims electronically. Using edits and claim scrubbers, they should know within seconds if your claims will be accepted or rejected, and resolve issues within minutes, not days. Correcting potential rejections before claims go to the payer can boost your first-pass rate to 99% and reduce denials.
- Reliable ERA Connections to Payers: Providing electronic remittance advice (ERA) to top national and regional payers is table stakes for a viable technology provider. This allows automatic posting and frees your staff to work on higher value tasks.
- Useful ERA Management Tools: ERA shouldn’t stop with payment explanations. Your vendor should provide ERA management tools to categorize and correct denials, manage appeals, find payments easily and print explanations of benefits (EOBs) for patients.
- Easy Electronic Secondary Claims Submission: Submitting secondary claims manually is an expensive, time-consuming hassle. Your revenue cycle technology should allow you to handle these claims electronically and provide dedicated secondary edits for faster submission, higher first-pass rates and a better chance of collecting all the revenue you earn.
- Essential Denial Management Tools: Denials are not going away any time soon, so your technology solution better have the right tools to manage them. At a minimum, you should be able to track and appeal denials automatically and generate prepopulated appeal letters to save staff time and increase productivity.
- Automated Patient Billing Solutions: Collecting from patients is getting harder and more expensive all the time. Your vendor should provide automated payment solutions that securely store patient credit/debit card information, automate payment plans and offer online billing and e-statements.
- Actionable Business Intelligence: All that data should help you work smarter, right? Your revenue cycle technology should generate relevant, actionable metrics in real time so you can adjust to improve productivity and cash flow.
- Valuable Analysis Tools: Detecting rejection and denial trends is the first step to increased reimbursement and staff productivity. A good technology vendor gives you tools to track and aggregate data over time to see the results of internal changes.
- Smooth Partner Integration: All the benefits of a great technology solution can go out the window if it doesn’t play nice with your other systems. Your claims technology should integrate seamlessly with your practice management and other electronic health record systems for productive, streamlined workflows.
- Outstanding Service: Technology is great, but some problems can’t be solved without human intervention. Your vendor’s client service team should resolve at least 95% of payer and reimbursement issues with one call or email.
A great revenue cycle technology provider cares as much about getting claims reimbursed as you do—and they have what it takes to get the job done. Does yours pass the test? If you’re not sure, contact Waystar, the combination of Navicure and ZirMed at www.waystar.com to learn about our revenue cycle technology solutions.