Healthcare RCM Platform: Integration with your EHR and other technology 

Revenue cycle management can be unruly, but much promise lies therein. 

Careful revenue cycle analysis shows you the:

• underpayments to demand
• key rates and terms to improve at renewal time
• denial root causes to fix
• payer contract performance data to leverage during negotiations 

All of these areas have the potential to improve net revenue. 

Still, the prospect of healthcare RCM platform integration into legacy systems makes some revenue cycle managers and CFOs hesitate.  In fact, HFMA found that this integration is a significant pain point for healthcare providers. 

The good news is that, despite some complexities, you can manage the integration of a healthcare RCM platform with little frustration, confusion, or staff resentment. The key lies not in a big budget or staff, but in adopting a disciplined and strategic approach. 

And optimizing your revenue cycle is one of the quickest paths to organizational viability. 

Bain & Co’s most recent “Global Healthcare Private Equity Report” surveys 200 healthcare organization executives. Bain concludes,

“Providers cite RCM as a top priority, anticipating higher spending for software across a broad set of subsegments including revenue integrity, charge capture, and complex claims management.” 

In fact, revenue cycle management is the top priority in the coming year, as the graphic below illustrates: 

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By committing to careful preparation, team training, and tracking, you can steer your RCM integration steadily. Here, we cover the steps in successful healthcare RCM platform integration. 

What is a healthcare RCM platform? 

A healthcare revenue cycle management (RCM) platform is a suite of software and processes that healthcare organizations use to manage all the financial and administrative aspects of patient care, from the initial patient registration and appointment scheduling to the final payment reconciliation. This integrated system tracks each patient's journey, encompassing critical functions such as insurance eligibility verification, accurate medical coding and charge capture for services rendered, timely claims submission to payers, diligent follow-up on denied or underpaid claims, patient billing, and collections. An RCM platform aims to streamline and automate the entire lifecycle of revenue generation, ensuring that all billable services are accurately documented, billed, and paid.

A well-managed revenue cycle ensures that providers receive accurate and timely reimbursement for the services they deliver, which is crucial for maintaining a steady cash flow necessary to cover expenses and invest in growth. 

Most providers today have turned many revenue cycle tasks over to automated software. Robust RCM technology helps providers navigate complex healthcare regulations, ensuring compliance with coding standards and payer policies, which in turn improves patient satisfaction through transparent and accurate billing practices.

What is healthcare RCM platform integration? 

Healthcare RCM platform integration refers to the process of connecting an RCM platform with other critical healthcare information technology systems, most notably the EHR, as well as patient scheduling, billing, and claims processing systems. The core goal of this integration is to create a seamless, automated flow of patient and financial data across these traditionally separate systems.

By integrating an RCM platform, healthcare providers can break down data silos, ensuring that information entered in one system (like clinical documentation in an EHR) is automatically and accurately shared with the RCM system for billing and financial management. Whether it's a simple sync between two systems or a complex web of data flowing between multiple platforms, effective integration leads to less manual data entry, fewer errors, and better compliance. Smart providers base their business decisions on comprehensive contract data.  

Case study: healthcare RCM platform and EHR integration at Mayo Clinic

Before the pandemic, Mayo Clinic had three different EHRs and 287 ancillary clinical and revenue cycle management (RCM) systems. 

Mayo’s fragmentation created organizational risks stemming from:   

• expenses related to maintaining disparate systems
• complex integrations (or lack thereof) 
• duplicative or conflicting workflows
• errors resulting from siloed information and inconsistent processes

Calling this untenable, they unleashed plans for a single integrated EHR and healthcare RCM platform. Getting it done took four unique implementations, 500 IT staff, two years, and $1.5 billion. 

If ever there was a complex integration, the Mayo system tackled it.

Today, all Mayo Clinic locations operate on a single, integrated system, giving patients and providers access to comprehensive information regardless of the care site. 

Integrating their healthcare RCM platform with their EHR allowed them to standardize over 1,400 workflows, impacting more than 51,000 end users, resulting in the streamlining of both clinical and administrative operations. The move also unified the data necessary to fuel not only accurate clinical research but also operational analysis.  

By consolidating its fragmented landscape, Mayo Clinic established a powerful foundation for significant cost savings and enhanced operational efficiency. 

Healthcare RCM platform integration best practices: 4 steps

Successfully integrating an RCM platform with your EHR and other healthcare IT technology is crucial for optimizing financial performance and operational efficiency. It requires careful planning and adherence to established best practices. These four steps will carry you through. 

1. Conduct a thorough needs assessment and workflow mapping before selecting integration tools

Before you even begin looking at specific integration tools or RCM platforms, you must understand your current environment and define what success looks like. This initial phase is foundational.

• Assess current systems and processes: Take inventory of all existing systems involved in your revenue cycle—EHRs, practice management systems, patient accounting systems, clearinghouses, and payer portals. Map out your current workflows in detail, identifying bottlenecks, manual processes, inefficiencies, and pain points. Understand how data currently flows (or fails to flow) between these systems.
  
  
• Identify gaps and define clear objectives: Based on your assessment, pinpoint specific gaps where integration can bring the most value.
  
  •  Are you struggling with high denial rates due to coding errors? 
  • Is manual data entry slowing down claims submission? 

Clearly define what you aim to achieve with the integration—for example, reducing A/R days by X%, increasing clean claim rates, or improving staff productivity. These objectives will guide your selection process and help measure success later.

• Involve stakeholders early: Integration impacts various departments. Engage representatives from billing, coding, front desk, clinical teams, IT, and finance from the outset to gather diverse perspectives and ensure the chosen solution meets broad organizational needs.
  
  

2. Prioritize solutions that support interoperability, scalability, and regulatory compliance.
The right technology choices are critical for both immediate success and long-term viability.

• Ensure true interoperability: This is paramount. Interoperability means enabling seamless, uninterrupted data exchange between your RCM platform, EHR, and other systems. It reduces data discrepancies, manual errors, and claim rejections, leading to quicker claims processing. Look for solutions that utilize standard protocols like HL7 and FHIR, and robust Application Programming Interfaces (APIs) to facilitate this structured communication. The goal is a unified view of patient and financial data.
  
  
• Plan for Scalability: Your healthcare organization will likely evolve. Select integration tools and RCM platforms that can scale with your growth, accommodate increasing transaction volumes, and adapt to new services or locations without requiring a complete overhaul. Cloud-based solutions often offer inherent scalability.
  
  
• Guarantee Regulatory Compliance: Healthcare data is highly sensitive. Ensure any integration solution rigorously adheres to all relevant regulations, particularly HIPAA, to protect patient data security and privacy during data exchange. This includes features like data encryption and access controls. Compliance with initiatives like the 21st Century Cures Act and CMS Interoperability Rules, which mandate payer-provider data sharing, should also be a consideration.
  
  

3. Invest in change management and staff training to ensure smooth adoption.
Technology alone doesn't guarantee success; your people are also critical. Addressing the human element of change is crucial.

• Implement a comprehensive change management strategy: New systems and workflows can be disruptive. Change management aligns staff with the reasons for the change and overcomes resistance to new ways of working. Develop a strategy that includes clear communication, stakeholder engagement, and addressing concerns proactively. Review our change management in healthcare article to learn how to win the best staff buy in and more. 
  
  
• Provide thorough and role-specific training: Ensure all staff members receive proper training on how to use the new integrated systems and perform redesigned workflows effectively. Training should be tailored to specific roles and responsibilities. It’s not just about how to use the system, but why the changes are being made and how they benefit the user and the organization. Of course, your change management plan needs to include this kind of clear communication.
  
  
• Offer ongoing support: Adoption is a process, not an event. Provide ongoing support post-implementation, including readily available resources, super-users within departments, and refresher training as needed. Also, give staff the opportunity to contribute, enhancing their sense of agency.
  
  

4. Monitor integration outcomes with analytics to drive continuous improvement.
Once your integrated system is live, the work of optimization begins. Data analytics are essential for understanding performance and identifying areas for enhancement.

• Establish key performance indicators (KPIs): Based on your initial objectives, define specific, measurable revenue cycle metrics to track the success of the integration. These might include clean claim rates, denial rates, days in A/R, cost to collect, patient satisfaction related to billing, and staff productivity.
  
  
• Leverage analytics and reporting tools: Advanced RCM software often features interactive dashboards and analytics capabilities. Use these tools for real-time monitoring of your KPIs, to identify performance trends, spot emerging issues, and benchmark your progress against goals. This allows for prompt corrective action.
  
  
• Foster a culture of continuous improvement: Regularly review performance data and solicit feedback from users. Use these insights to continuously refine workflows, optimize system configurations, and identify further opportunities for automation or efficiency gains. The goal is not just to implement, but to continually enhance your revenue cycle operations.
  
  

By diligently following these four foundational best practices, you can transform a complex integration project into a strategic asset. A disciplined approach will not only ensure a smoother transition but also maximize the long-term benefits of your RCM platform, leading to enhanced financial health and operational excellence for your healthcare organization.

Overcome provider integration concerns 

Healthcare organizations recognize the transformative potential of integrating revenue healthcare RCM platforms with the EHR and other technology systems. However, sometimes it takes overcoming several important concerns. Review these common concerns and their solutions to pave the way for your integration. 

1. Data interoperability and compatibility

• Challenge: Integrating these disparate data formats, communication protocols and workflows can be difficult, especially if legacy systems are involved or if the organization uses multiple vendors.
• Solution: Map out data flows and identify key data points that need to be shared (e.g., patient billing, scheduling, claims management). Choose integration tools or middleware that support multiple standards (like HL7, FHIR) and can flexibly connect current and future systems.

2. Workflow disruption and change management

• Challenge: Integration projects can disrupt established clinical and administrative workflows, affecting staff productivity and patient care during the transition.
• Solution: As mentioned above, take the time to develop a comprehensive change management strategy. Involve stakeholders from IT, clinical, finance, and operations early in the proces.
  

3. Data security and compliance

• Challenge: Integrating systems increases the risk of data breaches and compliance violations, especially given the sensitive nature of healthcare information.
• Solution: Ensure all integration solutions comply with HIPAA and other relevant regulations. Implement robust security measures, including encryption, access controls, and audit trails. Regularly review and update security protocols as systems evolve.
  

4. Vendor and system selection

• Challenge: Not all RCM platforms integrate seamlessly with all EHRs or ancillary systems. Vendor lock-in, lack of interoperability, and limited scalability can hinder future growth.
• Solution: Evaluate vendors for their track record in healthcare, integration capabilities, and support for industry standards. Prefer platforms with open APIs, proven interoperability, and strong customer references.

5. Financial and resource concers

• Challenge: Integration projects require significant investment in technology, training, and ongoing support. There’s also a risk of hidden costs if the scope expands or if unforeseen technical challenges arise.
• Solution: Clearly define objectives, timelines, and budgets. Understand all cost components, including licensing, implementation, and maintenance. Assess the potential ROI—integrated RCM-EHR platforms have been shown to improve collections and reduce administrative waste. You can also bring up the cost of not having integrated technology. 

6. Scalability and Future-Proofing

• Challenge: As healthcare organizations grow or merge, their technology needs evolve. Rigid or proprietary integrations can become obsolete or costly to update.
• Solution: Select solutions that are scalable and adaptable. Use integration platforms or middleware that can accommodate new data sources, workflows, and regulatory requirements.
  
  

MD Clarity’s healthcare RCM platform prioritizes revenue optimization

Integrating an RCM platform with existing EHR and other healthcare technologies is a strategic move that can yield substantial operational and financial benefits. However, it requires careful planning, stakeholder engagement, and a focus on interoperability, security, and change management. By addressing these concerns proactively, healthcare organizations can unlock the full value of their digital investments and position themselves for long-term success in an increasingly data-driven industry. 

MD Clarity’s contract management and monitoring solution, RevFind, is part of a healthcare RCM platform that ensures your net revenue is optimized. First, by centralizing, digitizing, and analyzing payer rates and terms, it identifies exactly where payers are underpaying for CPT codes. It also pinpoints locations struggling with underpayments and denials, so that you can address and fix these issues. RevFind also ranks payer contracts by performance, so you know which ones deliver the best value, providing crucial leverage for negotiations. Finally, it’s contract modeling features forecast the financial impact of proposed payer policy changes, enabling you to make informed decisions that protect and enhance your revenue.

 Schedule a demo to see how RevFind can ingest your contracts to render full visibility, insights and negotiation levers.  

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