Revenue Cycle Management Products and Services

Merge Financials 6.1 is a Windows-based radiology billing solution that aims to prepare physician practices for upcoming reimbursement changes, particularly the transition of electronic data exchange to the new ANSI 5010 required format. This release accommodates new PQRI (physician quality reporting initiative) procedures and can help organizations to begin the planning process for upcoming ICD-10 requirements. Full conversion of patient accounts and accounts-receivable data from legacy billing solutions is supported. This version also features capabilities for anesthesia billing, including charge handling and claim filing.

Merge Healthcare

Neural analytics and reporting tools have been integrated into the McKesson Total Payment solution via the InvestiClaim module. This module allows payers to avoid more wasteful and abusive claims up front and makes fraud recovery efforts more efficient on the back end. InvestiClaim incorporates the Total Payment claims auditing rules engine and claims operational data store, so clinical rules and pre-pay, data-driven analytics are combined on the same transaction platform. The solution also provides extensive workflow functionality for full collaboration among special investigations, claims operations and auditing departments.

McKesson

Epic billing software clients can now have seamless access to RealMed’s claims editing and error-management tools from within the same interface used for processing claims. The result is cleaner claims and fewer rejections by health plans. Epic clients who use the RealMed services receive error notifications with easy-to-understand messages for correcting the claims. When corrected, the user simply resubmits the claim using their system, and RealMed manages delivery to the health plans. Users can also verify eligibility and benefits in advance of appointments with RealMed’s all-payer eligibility and benefits application.

RealMed

The Access Quality Manager (AQM) is a rules-based, workflow-driven registration audit tool that enables hospital registrars to identify and correct patient data errors occurring during the initial registration process. The solution, developed with the aid of Orlando Health, helps health systems to reduce claims denials and accelerate payment processes by catching and correcting errors such as an incorrect member ID number prior to claims submittal. The solution can also serve as an education tool to train staff to avoid errors during registration.

QuadraMed

HFMA peer-reviewed Payment Integrity Services from Emdeon focus on key areas of the revenue cycle where providers traditionally lack the resources to address payer underpayments. From contractual underpayments, authorization issues, medical denials, coordination of benefits (COB) discrepancies, charge bundling, timely filing denials, current procedural terminology (CPT) coding conflicts to disparate claim systems, this services suite identifies what’s missing from your government managed care and commercial payer revenue bottom line.

Emdeon

MSC CareConnect is a proprietary online tool that allows for faster and more efficient claims management. Authorized claims professionals can log in to the secure, Web-based interface from anywhere to review and approve referrals. In addition to managing referrals, claims professionals receive e-mail notifications of status updates, authorization alerts, rental management prompts and links to claimant-specific referral history. This solution enables real-time, online management at different phases throughout the referral lifecycle.

MSC Care Management

OptumInsight (formerly Ingenix) has partnered with InstaMed, a healthcare payments network, to offer CareTracker Payment Connect, a new feature for OptumInsight’s CareTracker practice management system that makes it easier for patients to submit payments to physician practices. The solution automatically posts payments and reconciles financial records within the physician practice management system. It also allows patients to view their billing statements online and pay their bills via a secure online patient portal. According to InstaMed, physicians who give their patients more convenient choices for paying their medical bills may increase collections by as much as 200 percent.

OptumInsight