RCM/Financial Info Systems Solutions Guide

May 1, 2012

Eliminate paper-based payments

VeraFund Manager uses advanced payment and remittance processing support from BNY Mellon to deliver an end-to-end automated patient/payer solution for healthcare providers. This next-gen solution not only digitizes and processes paper-based payments from patients and payers, but also creates electronic remittance transactions from paper-based remittance advices, automatically indexes all correspondence, matches payments to original claims and prepares a posting file for easy import into an administrative system. Automatic reconciliation of payments, claims and bank deposits offers immediate return on investment. ZirMed

Salary-based premium calculations included

The HEALTHsuite administrative system now supports the variation of health insurance premiums based on employee income. This functionality provides tangible benefits to organizations looking to avoid the financial penalties associated with the Patient Protection and Affordable Care Act. The enterprise solution automates all aspects of health plan administration, including functionality for eligibility and enrollment, benefit administration, provider contracting and reimbursement, medical/utilization management, premium billing, care management, claims processing, customer service and contact management, reporting, EDI and more. RAM Technologies

Score a perfect ICD-10

The 10Smart Solution is an a-la-carte grouping of three product sets designed to facilitate a perfect ICD-10 transition. ClickON ClearView ICD-10 enables providers to validate newly coded claims from their host system against ICD-10 edits to ensure compliance. ClaimSmart Suite allows providers to bill ICD-10 coded claims electronically to all payers and easily track payments. A/Rchitect, a four-part, cloud-based set of products, spans the ICD-10 conversion continuum from preparedness first steps (such as historical utilization analysis) to post-conversion monitoring tools that aid in ongoing contract negotiation. SSI Group

Upgraded audit tracking and reporting software

AudiTrends Online, an updated version of the formerly titled Audit Tracker Online, expands the functionalities of traditional recovery audit contractor (RAC) software to allow healthcare providers to manage incoming medical record requests for all types of payer audits. These include private payers, quality improvement organizations and other Medicare- and Medicaid-based audits from initial medical records requests through stages of appeals and payment resolutions. This customizable software manages patient information, workflow, correspondence, audit determinations, various stages of appeals processes, deadlines and documents in one central and secure location. MRO

RCM with add-on cloud modules

Artiva Healthcare Advance is the newest addition to the Artiva line of hospital revenue cycle management software that improves the collection functionality of accounting systems, increases account representative productivity, maximizes management control and reduces administrative costs. This solution includes enhanced HIPAA and PCI compliance, new data service partners, hosted or on-premise options and access to cloud-based add-on modules and services, such as disaster recovery, speech analytics, cell-phone validation and authorization, e-consent and more. Ontario Systems

Improve front-end revenue cycle processes

The Access Integrity suite is designed to help healthcare providers improve cash collections, reduce front-end denials and improve efficiencies during patient registration. This flexible solution unifies disparate systems to remove complexity for patient access staff. Intelligent process automation and workflows presented through Web-based tools drive staff actions and deliver easy access to critical data required to financially clear patients prior to service. The result is a flexible, affordable solution to significantly improve an increasingly critical area of the hospital that impacts bad debt and patient satisfaction. MedAssets

Make supplemental documentation submission a snap

NaviNet Doc Xchange enables providers to send content-agnostic medical documentation electronically and securely to a variety of trading partners, including other provider offices and hospitals, health plans, government organizations and health information exchanges (HIEs). This solution eliminates mail- and fax-based submissions to streamline common healthcare processes. The impact to the provider revenue cycle can be significant, because delays in the settlement of a claim average 30 to 45 days when additional documentation is required, according to Empire Medical Services (EMS) and the Workgroup for Electronic Data Interchange (WEDI). NaviNet

Remote Hosting for revenue cycle and identity management

The QuadraMed Remote Hosting Service enables clients to reap the benefits of the company’s Identity Management, Revenue Cycle Management and Health Information Management solutions without the capital expenditures and staffing requirements associated with in-house hardware implementation, maintenance and monitoring. This solution is a great choice for organizations looking to alleviate the pressure on their in-house data center to devote more time to industry-wide mandates, such as demonstrating meaningful use. Downtime reduction and enhanced disaster recovery are other key benefits. QuadraMed

Certified for 5010 and pharmacy claims

INTERACTANT is 5010 certified to meet the upcoming mandates issued by Health and Human Services (HHS) to move from HIPAA 4010 to HIPAA 5010. 5010 files have been accepted using INTERACTANT since November 2010. HCS has received HIPAA 5010 certification through Edifecs, a CAQH CPRE-authorized testing vendor, for the 837I EDI Health Care Claim – Institutional and 837P EDI Health Care Claim – Professional. INTERACTANT has also completed D.0 certification testing through Medco Health Solutions, Inc. Previously 5.1 claims, INTERACTANT is now D.0 certified for institutional pharmacy claim transactions. Health Care Software (HCS)

Customer service anywhere, anytime

Customer Process Manager (CPM) enables organizations to deliver exceptional customer service anywhere, extending service to every customer channel, including via mobile devices and social media. This solution aims to ease work management with improved case management and knowledge management features, making sure that call center staff have the right information at the right time. Users can define customer service processes once and use them everywhere, including on mobile devices and in social media channels such as Facebook. Pegasystems

Get proactive and get paid

NextCare Patient Population Management integrates with NextGen Ambulatory EHR and NextGen Practice Management to automate contact with patients. Physicians can enhance care by ensuring patients are in compliance with treatment plans. The revenue associated with proactive patient communication and care is tracked, captured and processed through the integrated administrative workflow enabled by NextGen Practice Management. The redesigned EHR system boasts automated outcomes reporting, enhanced disease management workflows and content for more than 25 specialties. NextGen Healthcare Information Systems

Speed up payment for implants

LaClaro, maker of the Lighthouse revenue cycle management technology, has a new solution to help pinpoint problems, evaluate the profitability of implant procedures and identify ways to speed up the payment cycle by leveraging new data analysis for ambulatory surgery centers (ASCs). The new service offers a one-time Implant Payment Analysis report that drills deeply into two years of an ASC’s claims data and surfaces with a concise report on accounts receivables (A/R), payer history and revenue performance, comparing the overall A/R timeline for claims with and without implants. LaClaro

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