Looking to add new revenue streams and serve their clients, large EHR systems like EPIC and Cerner are expanding into solutions that tackle revenue cycle management (RCM) tasks in addition to records management. They now offer modules to track, manage, and automate prior authorizations, patient pay estimates, charge capture, coding, A/R follow-up, and more. Along with Experian and others, they are billing themselves as “end-to-end” revenue cycle solutions.
These EHR providers are encroaching on the territory of large companies that have been dedicated to end-to-end revenue cycle management tasks only from the start. Companies like Waystar and R1 RCM, which don’t offer EHR technology, have long promoted their end-to-end RCM services as the answer to overwhelmed healthcare organizations.
If you’ve been exploring revenue cycle management technology, you’ve probably stumbled upon end-to-end RCM company claims that using one company for all revenue cycle tasks improves your efficiency and net revenue, as well as employee and patient satisfaction. At the same time, you may be leery of locking yourself in with one technology for such a wide range of revenue cycle tasks. Possibly, you’ve also discovered RCM point solutions, providers that focus on just one or a limited cluster of revenue cycle tasks.
With the following pros and cons for each system, you can evaluate whether using your EHR or an RCM company for an end-to-end revenue cycle management solution or turning to a point solution will deliver the results you need.
What is end-to-end revenue cycle management?
End-to-end or “suite” revenue cycle management is an all-encompassing method of managing revenue integrity and the financial processes arising from all interactions between patients, healthcare providers, and payers. A comprehensive solution handles all operations tasks from booking appointments, determining eligibility, coding, billing, and claims processing and accounts collection. End-to-end RCM solution providers assert that integrating all components best optimizes the revenue cycle.
The EHR-affiliated RCM solution
Given a good experience with the EHR and a desire to streamline new technology additions, it’s understandable that healthcare organizations gravitate toward giving their current EHR a shot at handling their revenue cycle.
That direction may be warranted. A recent study of healthcare organizations’ top priorities revealed 80 percent of physician groups perceive their current EHRs as “good” or “very good” in general. Still, the tried-and-true may not necessarily fit your needs.
An end-to-end solution can seem like the easiest answer. If you started with accounts recovery or good faith estimates with one RCM solution, chances are their reps pressure you to examine net revenue possibly missed in charge capture or underpayments.
You’re already connected to their customer success team, and you know how they operate. Even if they’re not perfect, they have learned your business and they get important aspects of your organization done. After all, every vendor has some shortcomings. Why switch now?
Benefits of using EHR-affiliated end-to-end RCM
A centralized platform
The top benefit of leveraging EHR for end-to-end RCM is the integration of several healthcare management systems into one centralized platform. EHR platforms can consolidate workflow processes, which makes it easier to access patient data, coding, billing, and claims information. More streamlined data transfer between departments can lead to fewer errors. Further, some healthcare organizations just prefer dealing with fewer vendors. Implementing EHR for end-to-end RCM eliminates the need for outsourcing to additional third-party RCM companies.
Depending on the arrangement, using the EHR’s RCM functions may come with that “bundle” advantage where the more modules used, the lower the cost. If reducing costs associated with outsourcing fees is a priority, the EHR-affiliated solution could be for you.
Should the physician group or management care organization be a heavy user of an EHR/RCM company’s products, they may get faster attention and better service from that company. This advantage could reduce bottlenecks and give the organization greater control.
Reliable Compliance and Security
Tasked to make patient health information a primary goal, at this point, an EHR-driven end-to-end RCM system should be expert in encryption and protection. They are well-versed in regulatory requirements and security standards, and their platforms should employ robust security measures, including data encryption, user access controls, and audit trails, all of which safeguard sensitive patient information. Whether you choose a comprehensive or point RCM solution provider, make sure to establish the security measures involved during your evaluation process.
Drawbacks of using an EHR-affiliated RCM solution
Insufficient experience and expertise
We mentioned that most healthcare organizations give their EHRs high marks overall. Keep in mind, however, that when the study mentioned above drilled down into the specific value added, just half of the respondents felt they could call their EHR systems “good” or “very good” at saving them time. Just 47 percent call them “good” or “very good” for saving them money, and 40 percent claim they helped with staff workload and easing worker burnout. When trying to capture all the net revenue you can, mediocre results like these often don’t cut it.
When you consider the history of EHR providers, these underwhelming results are not surprising. Since 2009 with the passage of the HITECH Act, EHR software engineers have been working hard to streamline and secure records technology. EHR company talent has been selected and their products iterated to optimize records functions. It’s only recently that they’ve turned their attention to the revenue cycle, a very complex area with workflows, challenges, and opportunities all its own.
On the other hand, every dedicated (as opposed to EHR-affiliated) RCM company justifies its fees with promises of improving net revenue, saving time, cutting labor and other costs, and reducing workloads and staff burnout. Their technology has been precision-engineered to solve the revenue cycle’s biggest challenges and capture its most promising opportunities.
Focused on the interactions between payers and providers, an RCM company has been talking to revenue cycle staff and managers for years, even over a decade depending on the company’s history. RCM product managers listen to RCM staff pain points and provide solutions to make their jobs better. They’ve learned about the long hold-times typical of payer phone calls, tightening payer restrictions, unfavorable government legislation, the tendency for payers to underpay, and more.
Keep these drawbacks in mind when considering whether to take your EHR rep up on that RCM automation demo.
Dedicated RCM solution providers
As with EHR-affiliated RCM solutions, RCM providers that are not affiliated with EHRs assert that the consistency they provide results can save organizations money while improving clinician, staff, and patient satisfaction. Review these points to determine whether you need comprehensive revenue cycle support.
Benefits Of End-To-End RCM
Comprehensive RCM companies claim that when patient registration, eligibility verification, coding, claims submission, and payment processing exist in a single platform, following the patient journey becomes simpler and less prone to errors. These companies also argue that centrality helps organizations avoid duplicate efforts, which in turn reduces administrative burden and improves staff productivity.
Increased patient satisfaction
While not integrated with records, the comprehensive RCM system can provide patients consistent and transparent billing experience, a key factor in generating satisfaction, trust, and referrals. These solutions offer patient portals, where individuals can access their healthcare financial information, make payments, and view explanations of benefits.
Reliable compliance and security
End-to-end EHR companies claim that a solution that integrates all points in the revenue cycle keeps patient health information (PHI) safer than a point system. While they do integrate compliance controls directly into their platforms, so, too, do point solutions. All RCM solutions handling PHI must abide by HIPAA regulations.
Revenue cycle analytics and reporting
End-to-end RCM system providers assert that, because they have access to all points in the revenue cycle, their analytics can find and report on revenue leakage more efficiently.
End-to-end RCM solutions offer comprehensive reporting capabilities that apply advanced analytics to evaluate key performance indicators, identify revenue leakage points, and measure financial success. Consolidating data from various sources in a single system enhances the accuracy and speed of reporting, allowing healthcare organizations to find opportunities for improvement and make critical changes.
Drawbacks of end-to-end RCM solutions
While end-to-end systems offer several benefits, there are also some drawbacks to consider. Here are some of the negatives associated with implementing such a solution:
Handling many steps in the revenue cycle, a comprehensive solution may not only be pricey but involve charges for unused aspects of the system. You’re using revenue cycle technology to reduce waste, not increase it. Ongoing maintenance, updates, and training costs add to the financial strain. Smaller healthcare organizations with limited budgets often cannot afford end-to-end systems.
An end-to-end RCM solution could also be overkill for your organization. If you have a system or a stack of point solutions in place that already perform well, you don’t need a comprehensive system. Implementing one will result in duplicate efforts and cost-inefficiency.
Uneven accuracy and reliability
No matter how many reps claim expertise in every one of the over a dozen steps in the revenue cycle, every end-to-end solution has strengths and weaknesses across the revenue spectrum. Typically, each company started in one area and iterated in that area many times before picking up another revenue cycle issue to solve. There’s a reason the Best in KLAS awards have hundreds of categories. Waystar typically wins big in clearinghouse and claims management, but AccuReg takes the prize in patient access.
If your organization has prior authorizations buttoned up but needs precision work in coding and your end-to-end RCM solution shines most in prior auths, you won’t get your most dire revenue leakage points plugged.
Comprehensive RCM solutions can require significant training and time for staff to fully understand and utilize. This learning curve may result in decreased productivity initially, as staff members adapt to new processes and technologies. Does your organization have the time and bandwidth currently to make a significant change like this?
Staff availability limitations
Consider, too, that no matter the power of the comprehensive RCM system, if the physician group or management service organization does not have staff certified to handle certain points in the revenue cycle, those modules will most likely go unused. Some providers have a strong billing and coding team, but these individuals do not have the time or experience to sift through contracts and pursue underpaid claims. Staff availability and competency can significantly limit revenue cycle optimization whatever RCM solution you choose.
Healthcare organizations often have multiple legacy systems in place, and integrating them seamlessly into a comprehensive RCM system can be difficult and time-consuming.
Each healthcare facility operates differently, making customization vital. Comprehensive RCM solutions involve many interworking parts. Because adjusting one could impact several, these solutions can be hesitant to make the changes that will make your organization more efficient. More, given downstream effects, executing customization can take a long time. This lack of flexibility and speed could wind up undeserving your patients and frustrating your staff.
What are revenue cycle management point solutions?
Focused on individual revenue cycle tasks, point or bolt-on RCM solutions are powerful, targeted tools that achieve the best results for specific challenges. Engineered to integrate with other point solutions as well as EHR and practice management (PM) systems, point solutions stake their reputations on their product’s accuracy and effectiveness.
For example, when high deductible plans put an increased strain on revenue cycle workflows and the patient experience at a growing radiology practice in the Pacific Northwest, its business office looked for outside help to check benefits and provide cost estimates to patients. Where some solutions use past claim data to approximate costs in the estimates, to ensure precision, the point solution they adopted digested and digitized all of the practice’s current contracts, building the estimates from that data. The practice declared the benefit and estimate point solution a huge success, pointing out that,
“Other companies work off of past claim data and not actual contracts, so they just gave us a ballpark, but that’s not what we wanted. We wanted something that was extremely accurate.”
With benefit verification automated by 85 percent, a 45 percent drop in bad debt, and a 42 percent rise in patient collections, the practice conquered its most severe net revenue leakage.
By selecting different modules or vendors for each revenue cycle component, organizations can build a tailored solution stack according to their unique requirements.
When too much is not enough
You can compare a comprehensive RCM solution to that cool, multi-function jackknife you got in middle school. While the jackknife seemed to have everything you’d ever want or need, didn’t you just use the one big blade and maybe the scissors? The tiny file was too small to be good for anything, and the little metal toothpick was always too dirty to use. Plus, bulky and heavy, the jackknife didn’t fit in your pocket. Didn’t you end up depending on the single-blade folding knife that slid into your jeans like butter?
On the other hand, if you’re lost in the wilderness with nothing and need to build an entire shelter, you bet you want that serrated blade for cutting through bark as well as the tweezers for the splinters that result.
For now, the jury is out on whether end-to-end or stacks of point solutions will rule the future. Each healthcare organization's unique requirements should guide its decision.
Benefits of RCM point solutions
Healthcare organizations cite these benefits for prompting them to choose a point solution.
There are several reasons RCM point solutions deliver better net revenue in their specific areas.
First, given how much healthcare organizations differ, achieving specific goals takes customization. With a narrow focus and feature set, point solutions customize your products more quickly for smoother integration into existing systems and workflows. It takes a custom system to achieve optimal net revenue capture.
To remain compliant with 2022’s No Surprises Act, one reproductive healthcare group needed to send out good faith estimates to 445 patients daily. Current staff did not have the capacity to take on these tasks, and the organization did not have the hundreds of thousands of dollars to hire 4 to 8 new employees to get the work done. Their point RCM company delivered an estimate generation and sending solution requiring no intervention from staff, but serving their unique population would require some tweaks to the software. First, the range of services necessitated the creation of nearly one dozen estimate letters. Then, helping their atypical patients log into the portal took some adjustments. The director of revenue cycle explains that the solution worked because the point solution company,
“...partnered closely with us to help us use the product to support our business needs. When we needed complex fee schedules loaded and many changes to our letter templates, they accommodated every change we requested. More, they helped us develop our workflows so that we could operate efficiently.”
Secondly, the complexity of comprehensive RCM solutions can result in long training time and errors, impacting net revenue. Because RCM point solutions are designed for a specific task, they often come with simple, intuitive interfaces and workflows as well as quick training. This focused approach enables faster adoption and proficiency among healthcare staff, leading to increased accuracy and efficiency in revenue cycle management processes.
Finally, the healthcare industry’s dynamic nature necessitates solutions that can adapt and evolve rapidly. Point solutions are more nimble in responding to changes in government regulations, industry standards and payer restrictions than comprehensive systems are. When these changes go unaddressed, penalties and revenue loss can result. Most often based in the cloud and laser-focused on their piece of the revenue cycle, point solution companies continually update their products to conform to regulatory requirements and best practices so that revenue is not lost needlessly.
When you’re crystal clear on where your revenue cycle system is leaking, you need only adopt the required functionality, a move that contains costs. A specific solution keeps expenditures down and also helps organizations avoid the overlap and confusion that drains revenue. Smaller physician groups or clinics with limited budgets can benefit from point solutions as they can choose to invest in only the required functionality.
Point solutions help healthcare organizations target key RCM points without disrupting existing systems. As mentioned above, when your staff or other RCM solutions are performing well at multiple tasks, disrupting that workflow only triggers higher labor costs and other inefficiencies.
RCM point solution companies pride themselves on their expertise. Often smaller than comprehensive solutions, reps that can’t solve your issues quickly get you to the expert you need. Further, because integration is critical to their survival, they often can address broader needs involving other solutions or your EHR. End-to-end companies provide comprehensive support but may lack deep specialization to get your unique issues resolved for a specific point solution. When the system isn’t operating efficiently, net revenue is lost.
Control and compare
Vendor contracts can last one or multiple years. Physician groups and management service organizations with a stack of RCM point solutions enjoy more flexibility in their stack as contracts come due at different times. Should one of your vendors raise prices, it impacts a narrow point in your revenue cycle. If your end-to-end solution raises prices, costs increase significantly all at once. For instance, if you use ADP for payroll, recruiting, performance management, and they raised prices by 20 percent, you would be obligated to pay that higher rate across the board. Otherwise, switching performance or recruiting away from ADP would be time-consuming and costly.
Further, should you grow dissatisfied with one of your vendors, you can compare customer service, fees, and other factors within your tech stack. If one of your solution providers performs at a higher level, you can even explore whether you could switch the relevant services from the poor performer to them.
While comprehensive revenue cycle solutions offer a broader scope of functionalities, revenue cycle point solutions tend to be more accurate and effective due to their focused nature and simpler implementation.
RCM solutions are critical in today’s big-data healthcare environment
With the data generated in healthcare ballooning by 47% a year, it’s no wonder our revenue cycle staff are overwhelmed. The proliferation of diagnoses (225 new AMA codes in 2023 alone), medical devices, pharmaceuticals, genetic testing options, and patient-generated health information makes their jobs endless. The average hospital produces 50 petabytes of data yearly, twice the amount of data housed in the Library of Congress. Managing records and interactions between primary and secondary physicians and groups, as well as the payer, becomes a trek through a jungle of mind-numbing, confusing, and ever-changing details.
Whether you choose an end-to-end or a point option, you can support your staff with the AI, automation, and machine learning powering today’s revenue cycle management solutions. MD Clarity’s contract management tool RevFind and patient estimate tool Clarity Flow win physician groups significant returns, often in as quickly as 12 weeks.
RevFind enhances your financial performance and enhances the patient experience by centralizing your contracts and digitizing all terms and fees. This allows your staff to access the necessary data to ensure full reimbursement as specified in payer contracts and detect any underpayments. RevFind also compares your reimbursements to national standards such as Medicare. The analysis feature provides insights on contract performance metrics for each payer, enabling you to negotiate higher reimbursements based on competitive intelligence.
Clarity Flow simplifies insurance eligibility verification, generates accurate estimates of patient payments before services are rendered, and calculates co-insurance amounts. Request a demo to witness how our automation and operational efficiency solutions can benefit your healthcare organization at any scale.