Optimize Healthcare Revenue Cycles with athenaOne RCM Software | athenahealth (2024)

When it comes to getting reimbursed, large healthcare organizations today face significant challenges with getting paid. This includes the rising cost of supplies and services, along with regulatory and compliance costs, rampant physician burnout, and high rates of employee turnover.

Digging deeper, we see that only 38% of physicians believe their organization is on solid financial footing.1 When surveyed, the most common obstacles that U.S. physicians face today range from difficulty collecting full payment, to administrative burden, regulatory and compliance requirements, and growing industry changes. This data, along with the barriers to getting paid, pose serious threats to the long-term viability and sustainability of many healthcare organizations.

But what if there was a way for enterprise healthcare organizations to simplify the process of getting paid, so they could increase their collections for services rendered to patients? And what if they could actually decrease overhead at the same time?

Below, we’ll show you how you can update and improve the revenue cycle to help yield higher collection rates and increase efficiency to decrease the administrative burden on staff.

1. Improve operational efficiency

By working to streamline the revenue cycle and optimize workflows, your healthcare organization can help reduce administrative overhead by a significant amount, minimizing errors and redundancies and accelerating cash flow. A few key areas where operational efficiency helps drive revenue cycle management (RCM) success include front-end processes, such as registration, eligibility verification, and pre-authorization, as well as the medical coding and billing process where efficient coding can help minimize errors and delays. Regular audits can help you identify any coding errors or patterns that need to be addressed. Continuous efforts to remove administrative burden, reduce cycle times, and implement lean RCM processes yield significant operational gains, freeing up staff to focus on increasing patient satisfaction by supporting a smooth in-office experience.

2. Digitize bill payments and self-service actions

Focusing on enabling self-serve for patients, as well as incorporating digital bill pay, can enhance the patient experience and help your healthcare organization grow over time through patient retention and referrals. What does this look like? It could be things like self-scheduling appointments, paying bills through a portal online, messaging doctors conveniently, or all of the above. Providing self-service actions for patients helps provide them with flexibility around care and payment options and helps your healthcare organizations maintain schedule density without staff support. Digital bill pay may also help remove barriers to payment, so patients can make digital payments quickly and on their own time.

3. Gain visibility into financial performance metrics

How can you improve financial performance if you’re unaware of how your organization stacks up against competitors? You need benchmark data to help your healthcare organization grow and make improvements year over year. Certain RCM solutions can help you use metrics to enhance your perspective on the market by leveraging healthcare industry insights and benchmark data of other organizations similar to your own. This helps you understand what your peers are doing, what payers will require, and how to stay on top of it all. An RCM solution that includes a financial performance dashboard is an easy way to proactively address revenue challenges before they arise and can help your business identify new areas of potential growth.

4. Use a cloud-based RCM tool

A cloud-based RCM tool can actually help healthcare organizations save money on maintenance, energy, and operational costs compared to an on-prem tool. Using a cloud-based solution can give you access to real-time updates and data related to billing rules, medical coding, and more, with support software services that can help reduce burden and create cleaner claims. Managing your healthcare organization’s revenue cycle in the cloud can also provide better data security and reliability through encryption and regular backups and monitoring. What’s more, as your organization grows, you can scale cloud storage easily to accommodate new data.

With these tips and tricks, you can begin to implement sustainable improvements and changes into the revenue cycle, helping you position your organization for future expansion and increased revenue. So, how is athenahealth helping healthcare organizations to do exactly this? Let’s take a closer look.

How athenahealth’s RCM solution helps customers to collect more and increase efficiency

For over 25 years, athenahealth has been helping healthcare organizations to simplify the revenue cycle from appointment scheduling and patient registry, all the way to claims resolution and securing full payment. We help your organization to streamline revenue cycle management and optimize for efficiency, so you can get paid what’s owed. Using athenahealth’s revenue cycle services, healthcare organizations can drive financial performance across fee-for-service, value-based care, and hybrid payment models, proactively navigating regulatory changes to help reduce administrative burden.

Data from the healthcare consulting firm, co*ker Group, shows just how much athenahealth can help healthcare organizations improve financial performance.

I have seen firsthand how athenahealth makes a real difference for their customers. It’s not uncommon to see collections increase by 2-6% and overhead decrease by a similar margin. The innovative athenaOne solution has been a game-changer, enabling customers to enhance their financial performance and foster steady growth.

Jeffery Daigrepont, co*ker Group*

This data shows how the power of athenaOne can help healthcare organizations like yours to take revenue cycle and financial performance to the next level. After all, business growth is about integrating durable changes and process improvements that compound over time to produce success. So, let’s look at a few examples of how we help your organization succeed.

Here are just some of the ways that athenahealth helps your healthcare organization optimize financial performance:

1. Efficient scheduling for a robust patient roster

We start at the very beginning of the patient's journey with intuitive scheduling solutions that integrate seamlessly with the rest of the practice's operations, ensuring smooth patient flow and optimized appointment management.

2. Advanced medical billing rules engine to resolve claims quickly

Our extensive medical billing rules engine is at the heart of our RCM offering. Over 30,000 rules in our billing rules engine help catch possible errors before claim submission,2 minimizing denials and supporting a more efficient and precise payment process.

3. Claims creation and management for more efficient claims processing

With our sophisticated claims creation and management tools, we take the complexity out of this critical step. Our platform helps ensure that claims are processed efficiently and accurately, improving turnaround times and cash flow.

4. Denials management to proactively identify claims issues

Our approach to denials management helps identify potential issues before they result in denied claims. When denials do occur, our comprehensive review process makes resolution swift and straightforward, minimizing delays in payment.

5. Self-pay billing for easier patient payments

Our digital self-pay billing solutions are designed to make submitting payments as straightforward and simple as possible for both patients and practices, helping to increase satisfaction and improve collection rates. In fact, practices that use athenahealth’s online payment solutions have a 44% higher patient pay yield than practices that don’t.3

6. Real-time connectivity for comprehensive clinical insights

Our RCM solution has real-time connectivity with our Clinicals and Patient Engagement platforms. This integration provides practices with unparalleled insights across the entire patient care spectrum—from scheduling and billing to patient engagement and clinical outcomes.

In order to navigate challenges to reimbursem*nt and payment, your healthcare organization should work to reduce complexity throughout the revenue cycle process. Using the athenaOne all-in-one solution, your healthcare organization can see increased collections while also reducing overhead, helping your business get what’s owed quickly and efficiently. By taking action today, your healthcare organization can help ensure you’re optimizing collections and setting yourself up for future growth.

Interested in learning more? Try these related topics:

How healthcare organizations can optimize financial performance and increase revenue

Leveraging HIT solutions so your healthcare organization can achieve growth

Key ways your healthcare organization can use technology to simplify value-based care

*co*ker Group is an independent consulting practice that periodically provides onboarding services on behalf of athenahealth and athenaOne clients. Commentary reflects the real-life experience and opinions of co*ker Group, may not be representative of all athenaOne clients, and is not intended to represent or guarantee similar results.

  1. 2023 Physician Sentiment Survey, commissioned by athenahealth and fielded by Harris Poll, Jan 2024
  2. Based on athenahealth data as of Apr. 2023; M017
  3. Based on athenahealth data as of Dec. 2023. Patient Pay Yield (PPY) is the percentage of patient balance collected within 6 months of the date of service; M046
Optimize Healthcare Revenue Cycles with athenaOne RCM Software | athenahealth (2024)

FAQs

How to improve revenue cycle in healthcare? ›

Consider everything from the very first patient interaction to the final payment, and think about staff engagement and billing resources, too.
  1. Simplify patient access. ...
  2. Understand payer rules. ...
  3. Improve payment collections processes. ...
  4. Workflow automation. ...
  5. Staff engagement and training. ...
  6. Focus on the patient experience.

What is RCM optimization? ›

Revenue cycle optimization refers to the ways that healthcare teams can address revenue uncertainty by improving financial operations, from patient registration all the way to final payment processing. By making efficiency gains and reducing delays, procedural inefficiencies and revenue attrition can be minimized.

What is revenue cycle management software in healthcare? ›

Revenue cycle management (RCM) is the financial process, utilizing medical billing software, that healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance to ensure proper identification, collection and management of revenues from patient ...

What is the RCM workflow in healthcare? ›

What are RCM workflows? RCM workflows are the processes necessary for a physician or healthcare organization to get paid for the care they provide. RCM workflows include activities like eligibility verification, claim submission, payment capture, and denial management, to name a few.

What are the 6 stages of the revenue cycle in healthcare? ›

Revenue cycle starts with the appointment or hospital visit and ends when the provider or hospital gets paid fully for the services provided. The seven steps of revenue cycle include preregistration, registration, charge capture, claim submission, remittance processing, insurance follow-up and patient collections.

What is the biggest obstacle to good revenue cycle management? ›

Here are the top five challenges facing RCM teams in 2024, according to the report:
  • Timely patient collections: 48%
  • Managing denials: 36%
  • Hiring and training staff: 32%
  • Data analytics and reporting: 26%
  • Maintaining security and compliance: 13%
Jan 24, 2024

What are the key components of RCM? ›

Thus, in achieving a successful RCM, the following tools are essential: Failure Mode Effect (FMEA), Criticality Analysis, Fault Tree Analysis (FTA), Event Tree Analysis (ETA), Logical Tree Analysis (LTA), and other risk-based decisionmaking tools [9].

What is the RCM life cycle? ›

RCM serves as the vital circulatory system that keeps the financial health of healthcare organizations thriving. RCM encompasses a complex series of steps, from patient registration and appointment scheduling to insurance verification, claims processing, and reimbursem*nt.

What is the RCM methodology? ›

Reliability centered maintenance (RCM) is a corporate-level maintenance strategy that is implemented to optimize the maintenance program of a company or facility. The final result of an RCM program is the implementation of a specific maintenance strategy on each of the facility's assets.

What are the key concepts of the revenue cycle in healthcare? ›

The Healthcare Financial Management Association defines revenue cycle as “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” Basically, then, the revenue cycle is everything that happens from the moment a patient account is created (at ...

What is the key driver for effective revenue cycle management? ›

Revenue Drivers

The ultimate goal of RCM is reimbursem*nt, and there are several drivers to make that happen. Internally, the main drivers include provider productivity, patient volume, and set fees for services provided.

Why is RCM important in healthcare? ›

An essential fundamental function of any medical practice is Revenue Cycle Management (RCM). It is a company's brain and bloodstream. Without RCM, the revenue does not flow through the clinic and the practice is deprived of the much required cash flow for the clinic to thrive and grow.

How many steps are there in RCM? ›

In this article, we will highlight the 16 steps of the revenue cycle management process and discuss the importance of each step in ensuring financial stability for healthcare organizations.

What does RCM stand for in healthcare? ›

Revenue Cycle Management. Revenue cycle management (RCM) in healthcare is the business process that enables organizations to be paid for providing services. There are 17 unique steps in the revenue cycle, which begins with patient scheduling and ends with payment reconciliation.

What are the steps in revenue cycle management in healthcare? ›

The Medical Revenue Cycle in 9 Steps
  • Step 1: Pre-Registration. ...
  • Step 2: Registration. ...
  • Step 3: Charge Capture. ...
  • Step 4: Utilization Review. ...
  • Step 5: Coding. ...
  • Step 6: Claim Submission. ...
  • Step 7: Remittance Process. ...
  • Step 8: Insurance Follow-Up.
Apr 16, 2024

How do you optimize revenue performance? ›

Revenue optimization is a combination of pricing, demand, and marketing strategies used to maximize revenue growth. It involves taking a tactical, analytical approach to your pricing—requiring analysis of your price points, sales channels, and various other areas of your business—in order to maximize it.

What factors contribute to the complexity of the revenue cycle in health care? ›

The nature of service given by the health care organization is the one factor which affects the complexity of the revenue cycle. Another factor which leads complexity of the revenue cycle is the regulations in the health care organization which will lead to difficulty in billing and documentation.

What are the four primary methods for raising revenues to pay for health services? ›

The four basic modes of paying for health care are out-of-pocket payment, individual private insurance, employment-based group private insurance, and government financing (Table 2-1).

How can I improve my revenue collection? ›

How to increase revenues and sales
  1. Set defined goals. Make quantifiable goals for how much you want to increase your sales and revenue. ...
  2. Target repeat customers. ...
  3. Target former customers. ...
  4. Grow your geographic reach. ...
  5. Refine your pricing plan. ...
  6. Add products or services. ...
  7. Bundle products or services. ...
  8. Upsell products and services.
Mar 10, 2023

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