Hospital Revenue Cycle Management Solutions

Driving dollars to your hospital’s bottom line has never been more important. In today’s ever-changing healthcare market, it has also never been more difficult. Hospital revenue cycle management (RCM) is no small task, especially with limited resources and time.

The good news is that the right technology solution can make a difference. Your hospital staff can improve profitability and drive process improvement by integrating ZirMed’s powerful data-driven technology with your existing health information system. With ZirMed’s technology, you can achieve best-practice metric performance, seamlessly manage efforts, and leverage comprehensive reporting, resulting in process efficiency and improved revenue capture.

Take your hospital’s RCM to the next level with our powerful technology solutions that help you recoup and retain every dollar to which you’re entitled.

Want to learn more? Take a tour of ZirMed’s dynamic RCM solutions to help hospitals protect revenue:

Manage payer contracts to favor your hospital financially.

When it comes to hospital reimbursement methods, claims management is often top of mind. The reality is that hospital reimbursement begins with payer contracts. Faced with compressed margins, new payment methodologies, and increased contract complexities, your hospital needs the right contract management and modeling technology to guide future revenue decisions and ensure strong financial performance. Your revenue vitality depends on being nimble to change. By leveraging ZirMed’s contact optimization solutions, your staff is empowered to create, maintain, and model contracts in real-time.

Loading new contracts is also timing consuming, leaving you unable to assess whether payments are accurate. In many cases, underpayments occur due to a payer’s misinterpretation of contract terms. You need hospital RCM solutions that remove the complexities from healthcare contract management, enable payer contract modeling, and promote line-item payment monitoring. Here’s how ZirMed can help:

Real-time insurance verification and the ability to detect coverage in self-pay.

Eligibility verification before services are rendered is one of the most effective ways to reduce denials. Yet, doing so is easier said than done. Lapses in coverage occur frequently as patients change jobs or lose their employment. Other patients may have coverage under multiple plans, only one of which is the primary insurer for billing purposes. Newly-insured patients may not understand their benefits, and 80% of these patients are at high risk not to pay. The complexity and variation of today’s health plans can overwhelm even the most seasoned of staff members. You need hospital RCM solutions that provide accurate insurance verification at your fingertips so you can calculate remaining patient deductibles and check for hidden patient coverage after-the-fact. Here’s how ZirMed can help:

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

High deductible health plans (HDHP) and shifting employer cost strategies have ushered in an entirely new era of payer: the patient. When you don’t have a patient collections strategy in place, you risk losing valuable revenue due to unpaid patient balances. In some hospitals, 49% of patient balances are written off as bad debt. HDHPs force you to think more strategically about patient engagement, co-pay collection, and other self-pay payments. The stakes are high, and you need hospital RCM solutions that improve the patient experience while also making collections easier and more successful. Here’s how ZirMed can help:

Uncover hidden reimbursement by focusing on charge integrity.

Missed charge capture—often referred to as ‘charge capture leakage’— continues to plague hospitals nationwide, resulting in millions of dollars of lost revenue annually. A 5-15% annual revenue loss due to preventable revenue charge leakage is not uncommon. Manual charge entry, outdated charge description masters, and improper coding can all result in charge errors and omissions. You need hospital RCM solutions that apply machine learning, advanced data mining, and predictive modeling to detect missing claim codes as well as identify under-coded claims and charging anomalies to produce payment reconciliation and the development of charge capture best practices. Here’s how ZirMed can help:

Accelerate cashflow by managing claims reimbursement.

To maximize cash on hand, you must ensure claims are paid quickly and accurately. Yet, 15%-25% of your hospital’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. Claims management can be time-consuming which creates a costly resource drain. Not to mention, manual claims management lends itself to error. 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. Here’s how ZirMed can help:

Prevent write-offs and bad debt with denial avoidance.

As much as 3%-5% of your hospital’s net revenue is lost due to denials, despite the fact that approximately 90% of denials are avoidable. When denials do occur, you need solutions that pinpoint the root cause and streamline the management process, turning electronic remittance advice codes into actionable information that’s routed to the right team for resolution. Built-in, payer-specific, templates and the ability to batch denials and attachments together for delivery to the same payer allow you to streamline the process and simplify the workflow. The result? More revenue gained with less effort required. 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.