Provider Membership Information
revcyclematch.com reinvents the way you find your next revenue cycle business partner. Our platform is free-of-charge for providers and serves to eliminate false starts and service mismatches that slow down your business and cost you money.
We’ve done the heavy lifting for you, so all that is left is choosing the best fit. Our matching protocol means you only get responses from subscribed vendors who meet your specific business requirements. We value privacy, so revcyclematch.com enables you to search the platform anonymously until you decide to make a match. By using revcyclematch.com, you can quickly and effectively find your next revenue cycle partner.
These steps will walk you through the process:
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Revenue Cycle categories which contain solutions are listed below for easy navigation
Pre Service & Service Cycle
Scheduling Software and Services
Scheduling Software and Services aim to improve the match between healthcare resources (doctors, nurses, rooms, equipment, medicines) and patient needs. Scheduling Software and Services reduce wait times for patients while also improving the utilization of critical resources.
Call Center Software and Services
Patient Access and customer service call center software and services for hospitals, health systems, and medical practices, drive patient engagement, improve patient satisfaction, and optimize revenue opportunities.
Patient Identification and Address Verification
Patient Identification and Address Verification confirms patient identity, address, and demographic data against third-party sources to improve registration accuracy and the ability to communicate with your patients.
Eligibility and Benefit Verification Software and Services
Eligibility and Benefit Verification Software and Services is the process of checking a patient’s active coverage with the insurance company and verifying the eligibility and benefits available to expedite payment of the patient’s insurance claims.
Financial Counseling and Point-of-Service Collection
Patient Financial Counseling offers financial advice and assistance to patients regarding their medical bills. They are the liaison between patients and insurance companies, often coordinating payments and answering questions from both parties. Additionally, they collect payment from patients on behalf of the healthcare provider.
Authorization Software and Services
Prior and post-authorization is the process of getting an agreement from the payer to cover specific services before or after the service is performed. The Authorization process can be completed electronically or manually through a service offering.
ABN Checker Software and Services
An Advance Beneficiary Notice (ABN), also known as a waiver of liability, is a notice a provider should give Medicare patients before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.
Price Estimator Software and Services
A price estimate is the approximation of the charges, contracted cost of care and patient obligation. The price estimate is the product of the cost estimating process.
Medicaid Assistance/Enrollment Software and Services
Patients may qualify for free or low-cost care through Medicaid based on income and family size. Medicaid eligibility solutions and services assist patients through the process of Medicaid eligibility.
Health Insurance Premium Payment Assistance Services
HIPP is a Federal/State program currently in 37 states, where the state Medicaid agency pays the premium, coinsurance, and deductibles of eligible Medicaid patients to allow them to access private group commercial insurance or COBRA that is available to their family but unaffordable. This service assists patients in this process.
Presumptive Charity Eligibility and Propensity to Pay Software and Services
Presumptive Charity Eligibility is the process by which healthcare providers qualify patients for charity care as part of the benefit they provide to the surrounding community. Using technology that leverages credit-score-like data, estimated household size and income data, demographic information, and social media data, hospitals can determine whether patients are likely to qualify for charity care. Propensity to Pay automates the financial clearance of patients by condensing financial data into an easy-to-read format for quick decision-making during registration and financial counseling. This gives your organization a better idea of where patients stand financially and allows you to proceed accordingly.
Provider Credentialing Software and Services
Credentialing is the process of obtaining, verifying and assessing the qualifications of a healthcare practitioner to provide patient care services in or for a healthcare entity. To ensure consistency of credentialing, recredentialing, and privileging, a routine process should be followed.
Provider Enrollment Software and Services
Provider Enrollment is the process by which a medical provider gets entered into insurance plans, networks, Medicare and Medicaid so the provider can be paid for services rendered to patients.
Care Management Software and Services
Care Management Services, a team-based, patient-centered approach, is designed to assist patients and their support systems in managing medical conditions more effectively. Care Management software is used to manage and track patients within the healthcare and social services professions.
Patient Itinerary and Patient Experience
Itinerary-based scheduling is the concept of booking a well-coordinated set of appointments for clinical protocols and patient convenience.
Online Bill Pay Software
Online bill pay is a quick and secure way to pay your hospital, doctor or other healthcare bills online.
Dictation/Speech Recognition Software and Services
Dictation/Speech recognition software is an alternative to typing on a keyboard. Put simply, you talk to the computer or other device and your words appear on the screen.
Release of Information
Release of Information (ROI) in healthcare is critical to the continuity of care provided to the patient. It also plays an important role in billing, reporting, and other functions. Many laws and regulations govern how, when, what, and to whom protected health information is released.
A transcription service is a solution which converts speech (either live or recorded) into a written or electronic text document.
Coding Services Domestic
Domestic Medical Coding Services is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc.
Coding Services International
International Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc.
Coding Audit and Accuracy Software
A coding audit and accuracy tool is a comprehensive, customizable medical auditing solution, ideally with built-in workflow, audit management dashboards, detailed scorecards, and robust reporting. A coding audit and accuracy tool optimizes and accelerates the coding audit process. For hospitals and providers, it improves overall coding quality and compliance while providing the ability to access audited and scored records for education, review and process improvements.
Medical Coding Audit Services Domestic
Domestic medical audit services entail conducting internal or external reviews of coding accuracy, policies, and procedures to ensure you are running an efficient and compliant operation.
Medical Coding Audit Services International
International medical audit services entail conducting internal or external reviews of coding accuracy, policies, and procedures to ensure you are running an efficient and compliant operation.
Computer Assisted Coding Software
A computer-assisted coding system (CACS) is software that analyzes healthcare documents and produces appropriate medical codes for specific phrases and terms within the document.
Clinical Documentation Improvement Real Time Software
By electronically analyzing all relevant patient notes with AI technologies such as deep learning and natural language understanding, Computer Assisted Physician Documentation technology automatically identifies clinical indicators in a patient’s record and advises physicians in real-time when there is important missing information that needs to be clarified
Clinical Documentation Improvement Software and Services
Clinical documentation software and services are at the core of every patient encounter. In order to be meaningful, it must be accurate, timely, and reflect the scope of services provided. Successful clinical documentation improvement (CDI) programs facilitate the accurate representation of a patient’s clinical status that translates into coded data.
Registry Management collection services make clinical data available for clinical trials, cancer registry, and registries for trauma, stroke, bone marrow, etc. Registry Management serves the organization on an interim, functional, or full-strategic basis.
Revenue and Charge Capture Integrity
Revenue and Charge Capture Integrity solutions utilize advanced data-mining and machine-learning algorithms (AI) to find trends and deep insights into your data. In addition to detecting missing charges, their predictive models can identify over- and under-payment variances.
Charge Description Master Software and Services
The chargemaster, or charge description master (CDM), is a comprehensive listing of items billable to a patient or a patient’s health insurance provider.
Contract Management Software and Services
Contract management includes negotiating the terms and conditions of insurance contracts and ensuring compliance with the terms and conditions, as well as documenting and agreeing on any changes or amendments that may arise during its implementation or execution. It can be summarized as the process of systematically and efficiently managing contract creation, execution, and analysis for the purpose of maximizing financial and operational performance and minimizing risk. Contract management may also include systems that net accounts receivables to expected payment.
Claim Editor and 837 Submission Software and Services
A claim editing tool applies a rules-based engine to healthcare claims to help to ensure accuracy to receive payment promptly. Additionally, most claims editing companies provide clearinghouse services that send healthcare claims to insurers for payment.
HCC (Hierarchical Condition Category) Software and Services
HCC coding or Hierarchical Condition Category coding is crucial as it decides the reimbursement benefits for a Medicare Advantage Plan that uses ICD diagnostic codes as the primary indicators of the member’s health status. Since 2004, Medicare has used the HCC model to calculate payments to providers and health plans.
Post Service Cycle
Payment Processing Software and Services
Remittance data (either paper or 835 EDI transaction) is captured, accessible for searching, retrieving, downloading and more. Remittance data can also be manipulated into a viewable easy, consistent layout for all payers.
Cash Reconciliation Software and Services
Reduce costs and save time with auto reconciling of bank funds – EFT and ERA matching
Merchant software refers to merchant processing services that enable a business to accept a transaction payment through a secure (encrypted) channel using the customer’s credit card or debit card or NFC/RFID enabled device
Insurance Collection Workflow Software
A system that eases the process of collecting on insurance accounts receivables.
Patient Pay Workflow Solutions
A system that eases the process of collecting on self-pay or patient pay after insurance accounts receivables.
Insurance Accounts Receivable Services
Insurance accounts receivable or A/R is a term used to denote money owed to a healthcare institution for services you have rendered and billed. Any payments due from payers, or other guarantors are considered A/R. A goal is to manage its A/R to ensure that it gets paid correctly in a timely manner.
Denial Management Software
Denial Management software is designed to drill into your 835 remittance data to uncover the root causes leading to denials. It analyzes, tracks, trends, and reports on denial data, identifying unpublished rules and recommending fixes for individual denied claims while helping you identify and implement process improvements to eliminate recurring denials and optimize revenue. Denial Management software can also provide a system in which to resolve denials.
Denial Outsourcing Services
Denial Management services provide outsourcing or account specialists to assist in resolving denials and collection services.
Complex Legal and Care Management Denial Accounts Receivable Services
Complex Legal and Care Management Denial Accounts Receivable Services focus on claims that typically require legal or clinical intervention to finalize payment.
RAC (Recovery Audit Contractors) Services
Recovery Audit Services is the systematic process of reviewing disbursement transactions and the related supporting data to identify and recover various forms of overpayments and under-deductions to payors. In other words, it’s the recovery of lost money.
Auto, Workers Compensation and VA A/R Services
Auto, Workers Compensation, and VA Collection Services provide expert and detailed accounts specialists to follow up on the unique variations of these insurers.
Electronic Insurance Claim Status
Electronic Real-Time or Batch Claims Status Inquiry (CSI) allows you to electronically check the status of production claims after they have passed the front-end edits and received Claim Control Numbers (CCN). Through CSI, you will know if your claim has been paid, denied, or pending. It may also provide specific items on the payer’s website regarding your claim.
Early Out Self Pay Collection Services
An early-out self-pay program focuses mainly on reaching out to those patients that have patient responsibilities in a customer service environment and assisting with payment arrangements, charity care, patient statements and establishing a good working relationship prior to going to the collection agency stage.
Retroactive Insurance Verification
Retroactive Insurance Verification is utilized to identify missing insurance for active Self Pay Account. Retroactive Insurance Verification solutions query several eligibility sources to identify found Medicaid, Medicare, and Commercial coverage.
Patient Statement/Patient Portal
Patient statement solutions and services aim to be precise and easy to understand with clear statements related to information about the practice, cost breakdown of the services offered, date of statement, date due, remaining balance, and approved methods of payment, enabling the patients to pay on time
Patient Pay Financing
Patient Pay Financing firms provide patient finance solutions to hospitals, physician practices, and ancillary service providers. Patient financing helps patients pay their medical bills. A patient pay financing company is not a collection agency or credit card company.
Credit Scoring Software and Services
A credit score is a numerical expression based on a level analysis of a person’s credit files, to represent the creditworthiness of the person. A credit score is primarily based on a credit report information typically sourced from credit bureaus.
Presumptive Charity and Self Pay Segmentation/Workflow
Self pay segmentation provides an institution the ability understand the financial position of their patients, providing the ability to follow up with them more appropriately and provide a better patient experience.
Reserve Management is the process in which healthcare institutions value their net revenue and accounts receivable.
Cash Acceleration Services
Specialized follow-up services provide expert and detailed accounts specialists to follow up on targeted accounts receivable to convert to cash quickly.
Bundled Payment Software and Services
Under a bundled payment model, providers and/or healthcare facilities are paid a single payment for all the services performed to treat a patient undergoing a specific episode of care. An “episode of care” is the care delivery process for a certain condition or care delivered within a defined period of time.
Experts use industry experience to determine the best productivity solution for business needs by applying technology to day-to-day business interactions.
Full Revenue Cycle Outsourcing
In an outsourcing partnership, your partner would assume responsibility for your revenue cycle process encompassing an end-to-end approach of day to day management.
Payor Portal Access and Administration
Secure Payer Website Access Software
A secure portal to administer, manage and control all payer website access by hospital and physician practice staff. This software increases the productivity and efficiency to access all payor websites and ensures HIPAA compliance by allowing only authorized users access to ePHI and one click de-activation of non-authorized personnel.
Revenue Cycle Core Systems
Patient Accounting Systems
A patient accounting system is the subsystem of a hospital information system used for storing financial data, calculating healthcare costs, and providing patient and insurance billing information and functionality.
Practice Management / E.H.R
Practice Management Software and Services
Medical practice management software (PMS) is a category of healthcare software that deals with the day-to-day operations of a medical practice. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payers, perform billing tasks, and generate reports.
Archival and Retirement of Legacy Solutions
Archival Software and Services
Retiring and archiving legacy systems for compliance, record keeping is a necessity. Archiving enables you to decommission all associated hardware and software after retirement, eliminating the maintenance costs associated with these outdated systems.
Revenue Management Analytics
Unlocking disparate data in a unified fashion to power enterprise-wide reporting and performance analysis. Provides the linkages of core system data, legacy system data, bolt-on technology data, and select third-party data needed; into a fully unified framework to boost real-time access to data for data-driven decision making.
Artificial Intelligence | Machine Learning
Artificial intelligence (AI) is the use of algorithms and software to approximate human cognition in the analysis of complex data. AI does this through machine learning algorithms, which can recognize patterns in behavior and create its own logic.
Bad Debt Services and Solutions
Bad Debt Receivable Purchasing Groups
Bad Debt Receivable Purchasing groups, sometimes a collection agency, a private debt collection law firm, or a private investor that purchases delinquent or charged-off debts from a healthcare entity for a percentage of the face value of the debt based on the potential collectability of the accounts.
Collection Agencies are companies who collect unpaid debts for healthcare providers.
Medicare Bad Debt Software and Solutions
A provider’s bad debts resulting from Medicare deductible and coinsurance amounts that are uncollectible from Medicare beneficiaries are considered in the program’s calculation of reimbursement to the provider if they meet specified regulatory criteria.
Vendor Manager Software and Services
Vendor Manager software and services deliver healthcare organizations a workable scorecard into the collection agency and other vendor activity and performance; invoice verification technology to ensure commission accuracy, and reconciliation tools to show accounts being worked by the correct vendor according to contract standards.
Audit and Recovery Services
Transfer DRG Review Services
Under Medicare Post-Acute Transfer rules, certain DRGs are subject to reduced payments if patients are discharged early and receive post-acute care elsewhere. In many cases, patients do not receive the expected post-acute care for reasons outside of your control. Transfer DRG services review claims to ensure claims are coded correctly.
Disproportionate Share Software and Solutions
Federal law requires that state Medicaid programs make Disproportionate Share Hospital (DSH) payments to qualifying hospitals that serve a large number of Medicaid and uninsured individuals. Federal law establishes an annual DSH allotment for each state that limits Federal Financial Participation (FFP) for total statewide DSH payments made to hospitals. Disproportionate Share Software and Services assist clients in filing in accordance with regulations.
Zero Balance Review Services
Zero Balance or Closed-Accounts Collection Services perform a retrospective review of the claims from a billing, coding & reimbursement perspective in an effort to collect cash not received during the normal collection process.
Billing Compliance Software and Services
Applying industry regulations and specific institutional criteria to be sure all Revenue Cycle Billing processes are performing within the specified standards.
Financial Assistance Policy and Procedure Consulting
Applying industry regulations such as 501r and CMS standards is imperative to develop and implement a strong financial assistance policy and procedure for your institution.
Revenue Cycle Assessment and Consulting
As the healthcare landscape transforms, healthcare providers are being pressured to stay ahead of revenue cycle demands. Changing payment models from volume to value, shifting to increased patient liabilities, and increasing merger and acquisition activity are placing stress on revenue cycles. Health systems are challenged to become more integrated by bringing existing entities together, leveraging economies of scale, and providing cohesive patient service. Revenue Cycle Assessments and Consultants can assist across the continuum.
HIPAA Compliance Services
The Health Insurance Portability and Accountability Act (HIPAA) sets the standard for sensitive patient data protection. Companies that deal with protected health information (PHI) must have physical, network, and process security measures in place and follow them to ensure HIPAA Compliance.
Lean Certification Training and Consulting
Standardize your processes using Lean and Lean Six Sigma to improve care delivery, reduce errors and improve outcomes. Lean Certification training companies offer training specifically designed to develop and implement improvement methods and techniques in your healthcare organization.
Revenue Cycle Consulting
As the healthcare landscape transforms, healthcare providers are being pressured to stay ahead of revenue cycle demands. Changing payment models from volume to value, shifting to increased patient liabilities, and increasing merger and acquisition activity are placing stress on revenue cycles. Health systems are challenged to become more integrated by bringing existing entities together, leveraging economies of scale, and providing cohesive patient service. Revenue Cycle Consultants can assist across the continuum.
Cost Report and Reimbursement Consulting
Cost reporting and reimbursement consulting services are provided for both cost-based and PPS providers.
Interim Executive Placement
Interim executive placement firms partner with healthcare organizations to bridge the gap from a vacant position to the hiring of a new, permanent employees.
Revenue Cycle executive placement firms recruit and place healthcare professionals experienced in end-to-end revenue cycle solutions in varied capacities. Executive placement of experience revenue cycle personnel can range from sales and in business development, consulting and operations; wherever the critical RCM talent is needed.