Largest revenue cycle management (RCM) vendors

Which RCM vendor had the highest install volume?

Epic Systems Corporation has a clear lead over the other vendors we track and analyze using HospitalView. Epic’s RCM software has 2,575 installations and a market share of 37.24%. In second is Oracle Cerner with 1,915 installations and a market share of 27.70%.

These results aren’t too surprising, as Epic is also one of the biggest providers of electronic health record systems in the U.S. It’s common to find RCM services bundled with EHR systems or medical practice management platforms, as it’s a way of better handling patient engagement and ensuring claims remain organized, accurate and easily accessible.

What is revenue cycle management?

Revenue cycle management is exactly what it sounds like—a strategy that healthcare organizations can use to manage the administrative and clinical processes in their revenue cycle. This involves processing claims, collecting patient payment, communicating with health insurance payors, and more.

While this can be done manually, the complexity of the steps involved in the cycle means that there are many opportunities for costly errors to occur. RCM software automates the process and can help healthcare organizations properly navigate their revenue cycle, identify errors or leakage points, and ensure the facility is fairly paid for the services they provide.

What is the overall goal of revenue cycle management?

While the overall goal of revenue cycle management is to maximize a healthcare facility’s profits, patients can also benefit from a well-designed RCM process.

Part of a successful RCM strategy means making improvements to communication between the healthcare provider and the patient. Perspectives in the healthcare industry are shifting, and now price transparency is more important than ever. A facility can take strides to retain patients and build stronger relationships by letting patients know of expenses ahead of time. This way, there won’t be any unexpected surprises, and patients can make financial arrangements or request assistance as necessary.

What are the steps of the revenue cycle in healthcare?

The revenue cycle comprises seven steps:

1. Collect patient info: The cycle begins when a patient makes an appointment with a healthcare provider and provides personal information. This includes home address, date of birth, insurance info, phone number, and other details.
2. Charge capture: At this point, details about the services rendered are sent to billing.
3. Coding: CPT codes are assigned to diagnoses and medical services that insurance providers can refer to for reimbursement.
4. Claim submission: Once a charge is captured and coded, the claim gets sent to the insurance provider.
5. Insurance review: At this stage, the healthcare organization and the insurance provider may follow up on what has and hasn’t been paid.
6. Billing and collection: Once the claim has been verified and processed, it will become the patient’s responsibility to cover some of the service costs. Generally, these costs are determined during the first appointment so the facility can receive payment sooner rather than later.
7. Revenue cycle review: RCM software can make the most impact at this final stage of the cycle. Now that everything has been paid for, it’s time to review how the process went. What were the stumbling blocks? Is there any way to tweak the process to make it smoother for patients? This is where the organization can look at inefficiencies in the process and make improvements.

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