Gartner defines revenue cycle management (RCM) software as healthcare financial software that tracks and captures revenue received from patients and healthcare payers related to an episode of care. The software combines the administrative and clinical aspects of healthcare delivery by coupling patient financial and clinical data required for reimbursement. The revenue cycle management process begins at the time of patient scheduling, and it includes the process of obtaining eligibility, prior authorization, billing and collections and ends with account reconciliation. This market definition includes offerings from enterprise RCM vendors and consists primarily of vendors selling stand-alone software solutions.
Healthcare delivery organizations (HDOs) use RCM software to streamline and automate their encounter-based financial workflows and billing processes. The software enables patient access, claims submission, accounts receivable (AR) management, and federal and state regulatory compliance. When implemented in conjunction with an electronic health record (EHR) system, RCM software unifies administrative and clinical data for HDOs. This results in enhanced patient engagement; higher staff utilization; enhanced financial planning; reduced fraud, waste and abuse; and improved revenue capture.

Revenue Cycle Management Software

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It's such a people-driven process, but it's our role as technologists to actually educate and drive it that way and I don't think we do enough. Enterprise customers—especially the massive Fortune 500 companies—are the ones that I see as having the biggest challenges, and it’s not because they don't have the talent or the money. Being a Fortune 500 company proves they have enough money; they just don't understand that it's a cultural change that is needed. For example, we have to start by changing how we do portfolio management and financials, so can we stop funding projects and start funding products with a roadmap? And can we change the conversation to business outcomes that are measurable instead of tasks being completed or the deployment of a new feature that has brought no tangible benefit to customers? It's definitely about focusing more on the people and process. As technology executives, we know that better than anybody else and we don't do enough.

I don't know that there is a magic answer other than being realistic in setting expectations and managing the resource needs better. You also need to have software that's designed with an understanding that you can have whatever best practice or out-of-the-box capability you want, but it's almost never going to be a one-size-fits all solution. I see a lot of designs where they went in feeling optimistic and then started bolting on all sorts of stuff as the company grew and they dealt with things in real life. That’s how you end up with a Frankenstein monster at the end. It's hard to maintain.

At Viavi, any purchase of software is centralized within IT and we collaborate with global procurement. Governance around software purchase in terms of roles and responsibility and decision making is clearly defined. This promotes standardization and avoids duplication and wastage. There are quite a lot of software vendors out there, who promote business transformation focusing on a particular application and/or technology. It creates a false sense, that is, the software is going to solve business problems. Often fails to look at underlying business processes and drivers to address the need for transformation. When we work with our business partners, we take the tool/technology conversion out, we tell them, do not go by the fancy presentation by the vendors, we will get to the technology when we know what we are trying to solve. For transformations to be successful we need to look at the Business Problem that we are trying to solve, understand the key drives, acknowledge issues that need to be addressed. Clearly define what the end result is and how do we measure, is the measurement a revenue increase, optimize cost or measurable efficiencies. 
When we measure and tie investments to a proper return and make individuals accountable, we have a higher probability of making these initiatives a success.

IT leaders need to manage the change management cycle of the transformation initiative from end-to-end.

Effective change management and involvement of all stakeholders in IT projects for their valuable contribution!

Every board needs an IT leader who can help articulate the &#34;value of IT&#34;. And that leader may or may not be the CIO; they could be an independent non-executive director.

What strategies can IT leaders use to make a transformation initiative successful?

Is anyone here moving away from traditional ERPs? We're starting to transition from SAP R3/ECC to SAP S4 HANA, aiming to use it in its standard form. We've conducted show-and-tell workshops to assess the need for any deviations and plan to move core functions like customer care, CRM, and field service management to external systems. We're also integrating BillingPlatform Corp. for revenue and contract management, combined with Camunda for process automation. However, we're finding SAP's public cloud inadequate, especially in features like additional ledgers. We haven't fully abandoned classic ERPs yet, but are exploring a composable approach with best-of-breed systems, orchestrated by a central process engine like Camunda. This would connect to lean finance software rather than a full operational ERP. Are other companies considering this shift or are systems like SAP S4/HANA still the go-to choice?

Software Development Life Cycle (SDLC)

Hi.. I believe, it is definitely a bold decision to move from SAP to something else.. as SAP is a defacto standard. Due to this, SAP has been arm twisting customers for years &amp; still go on.. I&#39;d love to see a definitive alternative to SAPs of the world. The external integrations also are always an issue with SAP due to their policies regarding Digital Licensing (earlier Indirect Access).. However, laughable it maybe.. even after paying handsome amount at the time of license purchase &amp; obscene amount as AMC (which they keep raising every year).. They have the audacity to tell the customers what to do with their PAID ERP.. In Core SAP, they have not done much over last almost 3 decades.. keep acquiring companies &amp; adding them to expand their portfolio.. However, it definitely take huge amount of work &amp; guts to replace SAP.. 

Is anyone here moving away from traditional ERPs? We're starting to transition from SAP R3/ECC to SAP S4 HANA, aiming to use it in its standard form. We've conducted show-and-tell workshops to assess the need for any deviations and plan to move core functions like customer care, CRM, and field service management to external systems. We're also integrating BillingPlatform Corp. for revenue and contract management, combined with Camunda for process automation. However, we're finding SAP's public cloud inadequate, especially in features like additional ledgers. We haven't fully abandoned classic ERPs yet, but are exploring a composable approach with best-of-breed systems, orchestrated by a central process engine like Camunda. This would connect to lean finance software rather than a full operational ERP. Are other companies considering this shift or are systems like SAP S4/HANA still the go-to choice?

Best Revenue Cycle Management Software Reviews 2024 | Gartner Peer Insights

TrakCare provides comprehensive functionality for the management of healthcare information and workflows. User-friendly interfaces and scalability are the most appreciable features. 

TrakCare

InterSystems

MEDITECH Expanse

Optum Revenue Cycle Management

Revenue Cycle Management Software Reviews and Ratings

What are Revenue Cycle Management Software?

Products In Revenue Cycle Management Software Market

TrakCare

TrakCare

Gartner Research