Understanding the Claims Lifecycle: A Step-by-Step Guide
Grasping the details of the claims lifecycle in healthcare is crucial for getting timely reimbursements and maintaining financial well-being. As...
2022 was a tough year for healthcare providers… and patients. For providers, expenses outpaced revenue, driven up by the labor shortage, premium-priced outsourcing services and inflationary supply costs. For patients, job instability, insurance affordability and economic uncertainty caused many to put off treatment. The labor shortage impacted patient flow as well, leading to volatile volumes and capacity constraints. Margins were negative for eleven straight months, as visits continued to fall below pre-COVID levels and hospitals struggled to find and retain staff.
Industry analysts are optimistic that some of the circumstances that contributed to these challenges will improve in 2023. Hopefully they will, but no matter what happens, one thing is clear: providers must adapt their processes and strategies to survive in today’s complex climate. Reacting is no longer enough – it’s time to proactively evolve.
Solve healthcare challenges with innovative, end-to-end technology
What does that look like in practice? In a word, technology. Healthcare must catch up with other verticals and truly embrace digital transformation. Technology – more specifically: automation, interoperability, integration, and analytics – is the key to overcoming obstacles like the labor shortage today and building a foundation for success regardless of what tomorrow brings.
Revenue management is one of the areas most ripe for a technological makeover. Hospital leaders are realizing that the traditional patchwork of dozens of vendors is not only overly complex and expensive, it simply can’t keep up with the demands of modern business. As a result, many providers are taking a new approach to revenue cycle management, consolidating providers in a path to a holistic, end-to-end approach.
These integrated revenue cycle management (RCM) platforms use technology to increase staff efficiency and fill gaps in typically labor-intensive processes. They make it easier to manage revenue by getting patients estimates pre-service, ensuring that claims don’t get rejected due to avoidable errors, and tracking financial performance at all stages. With an end-to-end RCM platform, health systems can consolidate vendor management, realize flywheel-effect value, and ensure that all appropriate revenue is charged and collected, from point of service to final payment.
Evaluate RCM vendors with the Everest Group PEAK Matrix report
Like most technology, of course, all RCM platforms are not created equal. Some claim to be “end-to-end” but lack critical components or capabilities. Others struggle with integration, scale, or process coverage. To reap the benefits of an RCM platform, it’s important to find a partner that can deliver on its promise.
That’s where the Everest Group comes in. The analyst firm’s Revenue Cycle Management Platforms PEAK Matrix® Report 2023 comprehensively evaluates 15 RCM platform providers, giving revenue leaders an objective look at how industry offerings compare.
The report classifies revenue cycle management providers as Leaders, Major Contenders, and Aspirants based on the Everest Group’s RFI process, interactions with vendors, client reference checks, and an ongoing analysis of the RCM product market. It offers a sophisticated profile of each provider as well, including:
- Specific measures of capability across 10 categories, such as technology capability, flexibility and ease of deployment, portfolio mix, value delivered, and vision and strategy
- Information about each individual component of the platform and how they work together
- Multiple client case studies
- Detailed strengths and limitations
We’re proud that FinThrive was named a Leader in the PEAK Matrix report, with the highest score out of all 15 providers in “Vision and capability (the ability to deliver products successfully).”
We were also differentiated as the top technology provider that is investing in a comprehensive end-to-end, revenue management platform, offering flexible solutions across the revenue cycle that use KPIs to drive data-based decision making. At FinThrive, we strive to invest in the best technology and deliver incomparable value, and we are grateful that the Everest Group recognized our efforts.
An overly complicated and difficult healthcare environment needs industry vendors who aren’t afraid to lead. FinThrive brings more to the table for providers, demonstrating a true commitment to solving problems and driving the innovation that revenue cycle leaders expect and deserve. Our experts collaborate with you to find gaps in revenue management and develop a roadmap toward an end-to-end approach that’s built on data, analysis, and integrated technology. By tackling performance opportunities and consulting on areas of improvement, we achieve measurable results in management areas.
Strong data, better tech, and guaranteed performance are promises that many providers make but not everyone can deliver. The last few years have been hard, but we see 2023 as an opportunity to set higher goals, plan for the future, and make sure your partners are positive and actionable. At FinThrive, we can help you rethink revenue management so your organization can not only survive, but truly thrive.
To see how the Everest Group evaluated FinThrive and 14 other RCM providers, download the PEAK Matrix Report.