Revenue cycle management (RCM) is one of the most critical factors in running a successful medical practice. It helps to ensure that healthcare organizations are quickly and adequately reimbursed for their services. This is beneficial to both the provider and the patient.
RCM solutions are software that helps healthcare providers manage administrative and clinical functions within their revenue cycle. These solutions carry out every activity related to the organization’s billings and payments. Together with other platforms, they streamline revenue operations from appointment scheduling to final payment.
Top 10 Revenue Cycle Management Solutions
1. MD Clarity
2. Change Healthcare
4. Allscripts Revenue Cycle Management
9. Medsphere RCM Cloud
MD Clarity is an RCM solution that has served over 150,000 healthcare providers since 2010. Over this period, MD Clarity has worked with over 3,000 facilities and had over 20,000,000 patient encounters in the U.S.
MD Clarity’s services are tailored towards various healthcare institutions, ranging from ambulatory surgical centers to ophthalmology practices, health systems, and managed service organizations.
It helps its clients boost their patient experience and bottom line by automating activities in the revenue cycle, like cost estimates, payer underpayment detection, and contract optimization, all under one roof.
MD Clarity is also dedicated to helping you navigate the latest RCM practices and legislation concerning price transparency in healthcare. This way, you can improve your institution’s financial performance while ensuring a transparent experience for all your patients.
- Clarity Flow: This feature offers increased transparency for both patients and the healthcare organization. It gives your patients the confidence to get care and make up-front payments, with accurate out-of-pocket projections given before the service. It also sends the patients Good Faith Estimates compliant with the No Surprises Act via text, email, or letter.
- RevFind: An incredible tool that helps organizations discover any revenue leaks. It automatically detects, corrects, and appeals any claim underpayments and denials. The feature enables you to track payer performance and identify underpayments at the procedure level. This results in productivity because your staff won’t have to spend time poring over spreadsheets and manually updating fee schedules.
- Contract Analysis: This product shows you how your insurance contracts are performing and enables you to compare payer contracts so you can renegotiate terms if necessary. It also projects the cash flow impacts of any contract changes for informed decision-making.
Notable Clients: MD Clarity’s notable clients include Georgia Retina, Tahoe Fracture, Seattle Radiology, Florida Eye, and SouthSound Radiology
Headquarters: MD Clarity is headquartered in Seattle, Washington, United States.
Change Healthcare, formerly known as Emdeon and currently a part of Optum, is a revenue cycle management and payment solution that works with healthcare providers, pharmacies, payers, and third-party administrations to ensure a more efficient healthcare system.
Change Healthcare’s innovative technology and extensive network help healthcare providers enhance patient engagement, increase access, drive revenue performance, and ensure operational efficiency. The software helps organizations leverage their data and insights to improve the healthcare journey as a whole.
- Artificial Intelligence: Change Healthcare uses AI solutions to connect services and data, which helps eliminate silos between providers, patients, and payers, removing administrative inefficiencies that are often costly to the organization. Its AI solutions include Natural Language Processing (NLP), conversational AI such as chatbots that serve customers, and machine learning-based predictions that help improve workflows.
- API Integration: Change Healthcare’s platform integrates plug-and-play API solutions that streamline onboarding, increase adoption speed, and ensure workflow efficiency. These tools help power your consumer engagement and meet practice management needs.
- Data Interoperability: Change Healthcare provides data-driven interoperability solutions that help providers and payers improve their care quality, ensure better health outcomes, and reduce waste caused by inefficiency. These data tools give healthcare providers access to timely and comprehensive data, and the interoperability tools enable them to integrate their services into the healthcare ecosystem for a more streamlined healthcare journey.
Headquarters: Change Healthcare’s headquarters is in Nashville, Tennessee, United States.
Rating: Change Healthcare has a rating of 3.8/5 stars on G2.
Waystar is an RCM company founded in 2017 and built on the legacy of Navicure and Zirmed, two leaders in RCM. Over the past few years, Waystar has expanded to welcome other industry innovators like Ovation, Connance, Recondo, PARO, Patientco, Digitize, and eSolutions.
Waystar is dedicated to eliminating the administrative challenges that face healthcare providers by providing services that simplify healthcare payments across the entire revenue cycle. It enables you to unify all your healthcare payments and revenue cycle under one platform to increase operational efficiency, boost performance, and develop growth strategies.
Waystar is a Black Book top-rated vendor and 16-time Best in KLAS winner or Category Leader, providing award-winning support to over one million providers.
- Financial Clearance: Waystar provides cutting-edge payment collection tools that help you provide a convenient and personalized payment experience for your patients. It uses the latest technology and predictive analytics to simplify eligibility verification and authorization processes, give providers more visibility into patient propensity to pay, and empower patients to understand their financial responsibility.
- Revenue Capture: Underpayments, missing charges, and coding mistakes often lead to significant revenue loss in healthcare organizations. Waystar provides better data powered by machine learning and predictive analytics to help uncover and redeem missing revenue.
- Claim Management: With Waystar’s Claim Management Suite, you can automate claim monitoring, prevent denials and rejections before they happen, and streamline attachments. You can also work on both government and commercial claims in one place.
- Payment Management: Waystar equips your team with the solutions they need to maximize payment collection from patients and payers, providing a more transparent and convenient financial experience for the patients.
- Denial Prevention & Recovery: Waystar’s Denial Prevention + Recovery suite helps ensure fewer denials, reduces manual work, and increases your revenue.
- Analytics and Reporting: Waystar’s business intelligence tools and analytics help you make data-driven decisions that drive revenue.
Notable Clients: Premise Health, Clinicient, CHRISTUS Health, Piedmont Healthcare, Yuma Regional Medical Center, Halifax Health, East Tennessee Children’s Hospital, and more.
Headquarters: Waystar’s headquarters is in Louisville, Kentucky, United States.
Rating: Waystar has a rating of 4.5/5 stars on G2.
Allscripts Revenue Cycle Management
Allscripts, now known as Veradigm, is a data systems and services company founded in 2018. Like most revenue cycle management solutions, the company combines data-driven insights with actionable tools that help healthcare stakeholders improve healthcare delivery.
As healthcare evolves, Veradigm helps you stay competitive by improving your operational efficiency and ensuring you get the most out of your IT and business investments.
- Practice Management: Veradigm provides deep expertise and resources that help you drive performance by improving internal and external workflows in your practice.
- Enterprise Resource Planning: It helps your organization manage its supply chain and balance its bottom line through human capital management, automated inventory management, cost savings identification, and supply chain streamlining.
- FollowMyHealth: This unique mobile-first, customizable patient engagement platform helps healthcare providers promote healthy patient populations and manage quality. Through timely, relevant conversations, patients can play a more active role in their care, increasing engagement and patient satisfaction.
- Melissa Data: This feature helps organizations address verification functionality, including address maintenance, registration, place of service maintenance, and insurance carrier maintenance.
Headquarters: Allscripts is headquartered in Chicago, Illinois, United States.
Rating: Allscripts Revenue Cycle Management Services has a rating of 4.3/5 stars on G2.
DrChrono is an electronic RCM and electronic health record (EHR) solution provider that helps you improve efficiency by focusing on what matters most and taking care of the tedious administration tasks. With DrChrono, you get RCM services, a mobile EHR app, medical billing software, telehealth tools, and many other practice management tools.
- Medical Coding: DrChrono has a team of certified medical coders who review clinical notes and code accurately to eliminate lost revenue. These coders also help with clinical documentation compliance.
- RCM Task Manager: This is a helpful tool where you get real-time updates on all claims, so the team members can see the tasks to be completed for payment processing.
- Business Intelligence Tools: DrChrono also features Business Intelligence tools that provide up-to-date reports that you can use to improve your organization’s performance.
- Rejection Analysis and Resolution: DrChrono’s team of expert billers has a vast knowledge of rejections and works with insurance and clearinghouse companies to resolve rejections within 48 hours.
- Front-end Advice: DrChrono also provides valuable feedback on front-end transactions and how to improve them for higher clean claim rates.
Headquarters: DrChrono’s headquarters is in Sunnyvale, California, United States.
Rating: DrChrono has a rating of 3.6/5 stars on G2.
TriZetto Provider Solutions is an RCM platform that combines customer-centric services with intuitive products and industry expertise to simplify healthcare by providing complete revenue cycle management services.
The company started as Gateway EDI in 1984, rebranded as TriZetto in 2011, and was acquired by Cognizant in 2014.
- Claims Management: TriZetto empowers your organization to submit fast and accurate claims and minimize administrative burdens. TriZetto has over 8,000 payer connections and over 650 longstanding partnerships with practice management vendors.
- Patient Engagement: It helps you ensure patient satisfaction by providing a seamless, straightforward financial experience. Using their patient engagement solutions, you can have more informed conversations about financial responsibility and eligibility, which reduces hurdles that often impact patient outcomes.
- Denials & Contract Management: TriZetto’s tools help you maximize revenue recovery by effectively and efficiently monitoring every transaction to catch errors and automate the appeal process. The tools also boost your earnings by cutting payer contract risk.
- Billing & Coding: It has a team of in-house experts that you can leverage for billing and coding to cut down on the cost of hiring billers, coders, and follow-up reps.
- Credentialing: You can eliminate roadblocks and remedy operational inefficiencies by utilizing TriZetto’s Pulse portal and expert services that streamline credentialing.
- Analytics: TriZetto also provides in-depth data and insights that you can use to seize growth opportunities, improve overall performance, and achieve long-term goals.
Headquarters: Trizetto Provider Solutions is headquartered in Newport Beach, California, United States.
Rating: TriZetto has a rating of 4.5/5 stars on G2.
TruBridge is a platform that provides a host of RCM products and services to help you manage the administrative tasks crucial to your organization’s survival while you focus on caring for patients.
- Eligibility Verification: TruBridge’s eligibility verification tools help to reduce claim deductions, boost cash flow, decrease workload through automation, and improve customer service.
- Patient Liability Estimates: This RCM tool gives patients accurate out-of-pocket estimates, which helps you maximize point-of-service collections and reduce bad debt.
- Remittance Management: TruBridge provides a web-based solution that accepts more than 800 types of remittance data into compatible files, reducing posting errors and saving your team’s time and energy.
- Deposit Bank Reconciliation: It also matches deposits and remittances automatically, simplifying deposit bank reconciliation.
- Denial and Audit Management: With TruBridge’s cross-department workflow management tools, you can easily spot and fix any denied and audited claims.
- Reporting and Data Mining: This software reports every financial detail in claims and remits, so you don’t waste time looking for hidden data.
Headquarters: TruBridge’s headquarters is in Mobile, Alabama, United States.
Rating: TruBridge has a rating of 3.4/5 stars on G2.
FinThrive is an end-to-end healthcare revenue management company with award-winning RCM solutions designed to break the cycle of inefficiency. The company was founded in 2016 and has delivered over $10 billion in net revenue and cash to over 3,200 customers across the globe.
- Accurate Patient Estimates: FinThrive helps you provide patients with accurate and transparent estimates that help them understand the financial aspects of their care. FinThrive’s patient access solutions offer transparency, efficiency, and a seamless experience that increases engagement.
- Finance Data and Insights: FinThrive offers a 360-degree view of finance data, with rich insight that informs decision-making for improved customer experience and maximized revenue.
- Revenue Recovery: FinThrive’s tools help you capture even the hardest-to-reach revenue and maximize your reimbursement. Their full suite of solutions helps you improve revenue recovery processes and navigate financial uncertainty.
Headquarters: FinThrive’s headquarters is in Alpharetta, Georgia, United States.
Rating: FinThrive has a rating of 83.7/100 on KLAS Research.
Medsphere RCM Cloud
Medsphere’s RCM Cloud is a web-based end-to-end revenue cycle management solution. It aims to use digital solutions to replace manual, resource-intensive medical billing processes and optimize workflow through automation.
RCM Cloud and all associated services are delivered via the Medsphere Cloud Services platform. RCM Cloud is a suite of browser-based patient access and revenue cycle components designed to improve operational efficiency in healthcare organizations.
- Enterprise Scheduling: This tool features a drag-and-drop user interface that users can use to create customized views of their schedules. This is the coordinator for patients' resources that helps promote effective and timely scheduling of procedures and services.
- Patient Registration: This solution features several dynamic work queues that help users optimize their workflow. The tool also includes eligibility verification, POS payment entry, medical necessity checking, authorization processing, and optional propensity-to-pay.
- Patient Accounting: This tool provides a comprehensive billing solution tailored to help you maintain accurate control of financial data, with the flexibility to streamline your tasks.
- Collections and Payments: The Payer and Self Pay Collections module is a suite of integrated capabilities with a vast catalog of drill-down reports that automate and streamline payments.
- Informatics: The Informatics tool features a wide array of cutting-edge business intelligence dashboards, reports, and dynamic work lists that empower key healthcare decision-makers to analyze and act upon patient service and financial data.
Headquarters: Medsphere RCM Cloud is based in Sandy, Utah, United States.
Rating: Medsphere RCM Cloud has a rating of 4.6/5 stars on G2.
Dentrix Dental Systems is an RCM for dentists founded in 1985 and acquired by Henry Schein, Inc. in 1997. Dentrix is explicitly tailored to meet the evolving needs of dental offices through a host of cutting-edge tools and technology.
- Business Management: Dentrix offers a vast array of business solutions to help you improve patient care and your bottom line. The Dentrix Daily Huddle Report and Dentrix Practice Advisor are examples of business management tools that help your team analyze its performance and work towards meeting your practice goals.
- Practice Marketing: This suite of innovative tools helps you find any holes in your marketing plan, automate patient communication, and expand your marketing reach to attract and retain clients.
- Billing and Collections: These solutions help you streamline your claim submissions, create and send billing statements conveniently, manage your credit and debit card payments, and collect payments sooner.
- Clinical Efficiency: This suite of tools is designed to improve the patient’s experience through efficient workflows, reducing your workload and increasing patient satisfaction.
Headquarters: Dentrix is based in American Fork, Utah, United States.
Rating: Dentrix has a rating of 4.0/5 stars on G2.
Which Healthcare Revenue Cycle Management Solution is Best For You?
RCM solutions have different features designed to meet specific needs, so the best software depends on your size and specialty.
For large hospitals and other health systems, Change Healthcare is the best option.
If you run a dental organization, then Dentrix is your best bet. As an RCM software designed specifically for dentists, it provides integrated dental technology solutions and an array of software tools suited to the practice.
If you’re an outpatient or ambulatory healthcare organization, MD Clarity’s intuitive tools, like RevFind and Clarity Flow, are most suitable for you. If you’re interested in what MD Clarity has to offer, book a demo today to experience the MD Clarity difference.