Healthcare Revenue Cycle Management

Our revenue cycle management (RCM) solutions help optimize the consumer reimbursement process and reduce uncompensated care to improve cash flow.

What is revenue cycle management?

Revenue cycle management is the financial process that begins when a patient walks through the door and ends when payment is successfully collected. Revenue cycle management encompasses everything from patient estimates at the point of service (POS), to insurance eligibility verification (including copays and deductibles), financial counseling (including for charity care), pre-authorizations, coding claims, denials, reimbursements, billing and collections.

In short, revenue cycle management is the financial lifeblood for the healthcare industry and hospitals.

Why is revenue cycle management important?

Healthcare is expensive—and healthcare providers rely on incoming revenue to pay for it. But collecting revenue is highly complex and difficult. Consider the fact that healthcare providers uniquely must contend with:

  • Multiple payers (employers, health insurance carriers, Medicare and Medicaid, to name just a few) each with their own needs and incentives.
  • Complicated state and federal regulations, and a myriad of insurance policies, copays and deductibles.
  • Financially strapped patients—as of Q1 2016, approximately 51% of patients owe more than $1,000 to their healthcare providers. Nearly eight in 10 patients (77%) owe more than $500. (See the 2016 TransUnion Healthcare Report.)

Revenue cycle management's aim, therefore, is to help healthcare providers:

  • Automate as much of the revenue cycle as possible
  • Mitigate the complexity from multiple payers and complicated regulations
  • Collect much more revenue for healthcare services provided—at a lower cost

Revenue cycle management trends

  • Revenue cycle starts at the point of service: It pays to start the revenue cycle right when the patient walks in the door. Clear, accurate estimates, encouraging staff to ask for payment upfront, financial counseling, insurance discovery—these are just a few ways to increase revenue at the point of service.
  • Automation: Computer automation offers important efficiencies in revenue cycle management. As a rule of thumb, if staff must repeat complex manual tasks, it's a good place to look for automated solutions. For example, TransUnion eScan's patented data mining technology finds hidden third-party, Medicaid and Medicare coverage.
  • Patient is the new payerSM: Large copays and deductibles mean that for the first time patients now must shoulder more of the burden of healthcare costs. For revenue cycle management, that means healthcare providers will need to become far more consumer-friendly and price transparent.

TransUnion offers cost-effective solutions for all of these revenue cycle management trends and challenges. The key is to maximize reimbursements both in the front- and back-end of the revenue cycle.

On the front-end, ClearIQ, an intelligent, exception-based platform, enables providers to improve the patient access experience and maximize staff efficiency with task-driven, user-defined work queues. On the back-end, eScan, a post-service eligibility system, recovers reimbursements from third-party payers.

Both platforms integrate our HFMA peer-reviewed solutions and use TransUnion’s comprehensive consumer data and analytics to provide a clear picture of a patient’s financial health:

  • Patient access solutions more accurately verify patient identity, insurance eligibility, benefits and authorization requirements, and are rated highest by KLAS for accuracy in determining patient payment estimates
  • Collections and reimbursement solutions help you more accurately predict a patient’s ability to pay and likelihood to qualify for financial aid, as well as uncover unidentified sources of third–party insurance coverage
  • Healthcare resellers and channel partners solutions deliver easy-to-integrate revenue cycle data solutions to provider clients for deeper insight into their patients' identity, financial and insurance situations

Let TransUnion Healthcare's revenue cycle management solutions help you better understand your patients’ true financial situation and efficiently move them through a stressful aspect of being a patient.

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