Health System Revenue Cycle Management Solutions

Ensuring financial success across your health system is a monumental task. With ever-changing payer requirements and an increasing patient responsibility, it seems to get more difficult every day.

The good news is that the right technology solution can make a difference. ZirMed’s powerful data-driven health system revenue cycle management solutions allow you to coordinate efforts across multiple settings to gain a big picture view of overall performance. By integrating directly with your existing health information systems, ZirMed’s technology helps you make informed business decisions and gain efficiencies by streamlining processes through a single platform. Take your health system’s revenue cycle management (RCM) to the next level with ZirMed’s powerful solutions that drive dollars to your bottom line and help you stay competitive.

Want to learn more? Take a tour of ZirMed’s comprehensive RCM solutions to help health systems maximize revenue:

Manage payer contracts to favor your health system financial performance.

Contract negotiations have a big impact on health system reimbursement. Yet, contract forecasting and modeling is labor intensive and drains system resources. Just loading and maintaining contracts is a time-consuming and costly process. Then you must also monitor payment accuracy across hundreds, even thousands, of contracts. You need health system RCM solutions that simplify the daunting task of contract negotiations, making it easier to predict system-wide performance and reconcile health system reimbursement. ZirMed’s contract management platform supports the ability to monitor payment variance, resulting in the timely reconciliation of claims and the avoidance of revenue leakage. Here’s how ZirMed can help:

Real-time eligibility verification and detection of coverage in self-pay.

In today’s ever-changing healthcare market, determining patient eligibility can be tricky. Lapses in coverage occur frequently as patients change jobs or lose employment. Other patients may have coverage under multiple plans, only one of which is the primary insurer for billing purposes. The complexity and variation of healthcare plans

In today’s ever-changing healthcare market, determining patient eligibility can be tricky. Lapses in coverage occur frequently as patients change jobs or lose employment. Other patients may have coverage under multiple plans, only one of which is the primary insurer for billing purposes. The complexity and variation of healthcare plans is overwhelming, and it becomes even more difficult to manage as your health system increases its market share. You need health system RCM solutions that provide accurate eligibility information at the point-of-care so you avoid costly denials due to lack of coverage. However, sometimes insurance eligibility cannot be captured on the front-end. ZirMed’s insurance verification products include RCM solutions that not only ensure eligibility on the front-end, but also identifies coverage in self-pay patients which can ease the burden of patient collections.  Here’s how ZirMed can help:

Capture revenue with point-of-service and self-pay patient collections.

Recent government regulations have transformed the reimbursement landscape as we’ve known it, and now your health system is faced with the daunting task of collecting directly from patients, many of whom have high deductible health plans. You must think more strategically about patient engagement and ease of payments across multiple settings. You need health system RCM solutions that make it easier for patients to pay the many providers they may see for a single episode of care. Here’s how ZirMed can help:

Identify hidden health system reimbursement by focusing on revenue integrity.

Missed charge capture—often referred to as ‘charge capture leakage’— is an ongoing challenge that costs health systems millions of dollars annually in lost revenue. The problem of manual charge entry, outdated charge description masters, and inaccurate charge capture automation is multiplied exponentially in health systems that include physician practices and other ambulatory providers. You need health system RCM solutions that apply both predictive modeling and rule-based logic to identify charging anomalies spanning multiple settings. Doing so allows for prospective reconciliation and the development of charge capture best practices. ZirMed’s revenue integrity solutions are designed to improve health system reimbursement by linking hospital and professional fee data on a single platform for more actionable intelligence, comprehensive reporting, and anomaly detection for the entire health system—even when integrated with disparate HIS systems. Weaving this data together makes it easier to look for missing charges and coding errors, boosting your health system’s financial performance. Here’s how ZirMed can help:

Accelerate cash flow by managing your health systems’ claims management and reimbursement.

To maximize cash on hand, health systems must ensure claims are paid quickly and accurately. Yet, 15%-25% of your health system’s net charges are at risk due to untracked claims. A manual reconciliation process makes it nearly impossible to pinpoint each claim’s movement through the payment lifecycle. You need automated remittance processing and reimbursement deposit management to gain real-time cashflow insight. By automating reconciliation, you eliminate thousands of hours wasted on labor-intensive manual processing, reduce the risk of errors, auto-post pre-reconciled download files, and expose missing items—all in a matter of seconds. In order to maximize return, you need a clearinghouse designed for health system claims management.  That’s why ZirMed’s claims management solutions make it easy to manage both institutional and professional claims for the entire health system within one solution. Here’s how ZirMed can help:

Simplify workflow with denial avoidance.

Managing denials across multiple settings requires a coordinated effort that is both time consuming and resource-intensive. This effort must also be proactive, focusing on compliance-driven coding and billing. Chasing denials retrospectively is not the answer because there is a lack of long-term return on investment. You need health system RCM solutions that use predictive analytics to identify potential denials before they occur—and before payers find them. You also need solutions that streamline the denial management process, turning remittance codes into actionable intelligence that immediately provides insight into what payers deny and why. ZirMed’s denial management solutions include built-in payer-specific templates as well as  the ability to batch appeals for denied claims and attachments together for delivery to the same payer allow you to streamline the process and simplify the workflow. Robust analytics and reporting capabilities help you understand overall system performance and areas of vulnerabilities. Here’s how ZirMed can help:

Integration Capabilities

By design, ZirMed’s revenue cycle management platform enables creators of healthcare technology solutions to seamlessly and easily incorporate our HIPAA and PCI-compliant applications and transactions into your software solutions. Using ZirMed’s integration capabilities, organizations seeking a traditional approach of exchanging EDI transactions may transmit and receive a variety of claims, payments, eligibility inquiries, and other healthcare transactions using established technologies and methods such as X12 files, APIs, Flat Files, FTP, Encryption (i.e. PGP), and more. You’ll have confidence knowing that your exchanges are occurring securely, in compliance with all regulatory guidelines, and utilizing existing technological capabilities.