May 13, 2016
Written by Carrie Pallardy, Kelly Gooch and Brooke Murphy
Revenue cycle management is essential to any business’s strategy. These processes are only growing in importance in healthcare as every dollar is expected to stretch further than before. Here are 113 companies that provide revenue cycle management solutions specific to the healthcare industry.
3M Health Information Systems (Salt Lake City). 3M Health Information Systems offers a number of RCM products and services. The company’s 3M Ambulatory Revenue Management Software is designed to reduce compliance risks and achieve maximum reimbursement in the outpatient setting. The company also offers the 3M APCfinder with medical necessity validation, which focuses on CMS’ Outpatient Prospective Payment System. The solution allows users to apply medical necessity at the point of coding.
Accretive Health (Chicago). Accretive Health offers revenue cycle management services, physician advisory services and value-based managed services. Operating together, Accretive Health partners with hospitals and health systems to reduce administrative costs, enabling providers to focus on their core mission: delivering high quality care. The company’s revenue cycle management services portfolio includes creating a distinctive operating partnership model, aligning financial relationships and providing propriety technology and data science.
Acustream (Lafayette, Colo.). Acustream’s proprietary RevBuilder enterprise solution uses both client hospital billing and/or professional billing data, facility specific rules (FSR’s) and predictive analytics to find reimbursable “never billed” charges. Not a collections tool, RevBuilder finds dollars in the data that were missed for any number of reasons. The business model is 100 percent contingency-based.
Adreima (Downers Grove, Ill.). Adreima has solutions that address the front, middle and backend of the revenue cycle process. The company’s services include eligibility, medical prior authorization review, charge description master, charge capture, receivables management, clinical denials and appeals, clinical audit support and post payment recovery.
AdvantEdge Healthcare Solutions (Lombard, Ill.). AdvantEdge Healthcare Solutions is a medical billing and practice management company. The company offers revenue cycle management and business management solutions to hospitals, hospital-based physicians, office-based physicians, behavioral health providers and surgery centers. AdvantEdge’s portfolio includes medical coding and billing, revenue optimization, informatics, compliance and more.
The Advisory Board Company (Washington, D.C.). The Advisory Board Company is a global research, technology and consulting firm that provides performance improvement services for healthcare and higher education. The company’s revenue cycle services include denial and bad debt management, documentation optimization and more. The Advisory Board Company partners with more than 230,000 leaders at 5,200 organizations.
AGS Health (New York). AGS Health offers medical billing, coding and business analytics services. The company includes more than 2,500 employees in the United States and India. AGS Health manages approximately $1.1 billion in receivables each year.
Allscripts (Chicago). Health IT vendor Allscripts offers an analytics toolset geared toward revenue cycle challenges. The company has a 99 percent net collections rate, 98 percent first pass clean claims rates and a 5 percent average increase in collections. Allscripts Revenue Suite and Services offers pre-claim solutions, claims submission, inbound processing, A/R management and more.
Alvarez & Marsal (New York). Alvarez & Marsal is a global consulting firm with headquarters not only in New York, but also London, Sao Paulo and Hong Kong. Amongst its many services, the company offers revenue cycle optimization and financial services to the healthcare industry. Guy Sansone, based in New York, is the head of the company’s healthcare industry group.
AmkaiSolutions (New York). AmkaiSolutions is a software company that caters to the ambulatory surgery center, surgical hospital and specialty practice industries. The company offers an EMR, billing software and more. The company’s product AmkaiEnterprise is designed to reduce operating costs, enhance analytics capabilities and improve quality of care.
Anthelio Healthcare Solutions (Dallas). The company offers IT services, EHR and optimization services and its Pyramid HALO RCM services. Anthelio acquired RCM company Pyramid Healthcare Solutions in July 2015 to expand its revenue cycle offerings. The company’s RCM portfolio includes HIM outsourcing and optimization, medical coding, coding audit and education, revenue assessment and analytics, patient financial services, clinical documentation improvement, transcription and voice recognition, ICD-10 support and more.
athenahealth (Watertown, Mass.). athenahealth offers cloud-based services from electronic health records and population health management to patient care coordination and revenue cycle management. The company’s revenue cycle tool is athenaCollector. Each quarter, the company submits approximately 27 million claims, and 94 percent of these claims are resolved on first submission.
Availity (Jacksonville, Fla.). Availity caters to physician practices, hospitals, health plans and vendors. The company’s revenue cycle solutions address patient access issues, as well as the full spectrum of revenue cycle functions. The company also offers add-on modules that range from advanced claims editing and comparative analytics to self-pay eligibility verification and workers’ compensation.
Bank of America Merrill Lynch (Charlotte, N.C.). Bank of America Merrill Lynch offers a number of healthcare solutions including revenue cycle solutions, employee benefits integration, profit enhancement, streamlining operations and more. In addition to financial solutions, Bank of America Merrill Lynch offers mergers and acquisitions services and transaction services.
BESLER Consulting (Princeton, N.J.). BESLER has provided financial and operational consulting to the healthcare industry since 1986. The firm offers transfer DRG revenue recovery and software solutions, coding and compliance, readmissions analytics tools, comprehensive revenue cycle assessment and more.
Bolder Healthcare Solutions (Louisville, Ky.). Bolder Healthcare Solutions has a number of revenue cycle management services. The company’s Avectus Healthcare Solutions resolves third-party liability claims for the hospital and trauma center market. Bolder’s ROI Companies is a full suite of RCM services for hospitals. The company’s portfolio also includes Bolder Anesthesia Management, Bolder Billing Services and Bolder Outreach Solutions.
The Camden Group (El Segundo, Calif.). The Camden Group is a national healthcare business advisory firm. Services include financial advisement, clinical integration, business planning, operations improvement and more. In the realm of financial advisement, the firm offers payer contracting support and value-based payment modeling, amongst other services.
Cardon Outreach (The Woodlands, Texas). Cardon Outreach manages $10 billion in accounts on an annual basis. The company provides eligibility services, accounts receivable services, disability solutions and services to increase revenue recovery of patient self-pay. Cardon also has technology solutions including its integrated proprietary technology platform MPOWER.
CareCloud (Miami). CareCloud aims to offer an all-in-one RCM solution, which encompasses claims submission, payment posting, payer follow-up and patient billing. In addition to RCM services, CareCloud offers practice management, EHR, patient engagement, mobile app and healthcare analytics services.
Cerner (Kansas City, Mo.). Cerner is the world’s largest publicly traded health information technology company providing leading-edge solutions and services for health care organizations worldwide. In addition to its core revenue management solutions, the company provides billing and coding services including charge processing, A/R follow up, eligibility checking, denials management, cash posting, self-pay and early out as well as full business office management for acute and ambulatory venues.
Change Healthcare (Nashville, Tenn.). Change Healthcare, formerly Emdeon, focuses solely on revenue cycle management and clinical information exchange solutions. The company serves providers, payers and pharmacy service providers. Emdeon’s network includes 340,000 providers; 1,200 government and private payers; 5,000 hospitals; 105,000 dentists; 60,000 pharmacies and 600 vendors.
Citadel Outsource Group (Hendersonville, Tenn.). Citadel Outsource Group is an outsourced business office financial services company. The company’s revenue cycle services include billing, claims resolution, denial management, discrepancy management, business office management, interim revenue cycle consulting, cash posting, revenue cycle assessment and more.
Citi’s Money2 for Health (New York). Money2 for Health focuses on the patient payment process function of the revenue cycle. This service from Citi Group allows patients to pay healthcare bills easily by linking to checking accounts, health savings accounts and flexible spending accounts. The platform was launched in 2013 in partnership with Aetna and Parallon, a subsidiary of HCA.
The Claro Group (Chicago). The Claro Group, a healthcare consulting firm, has a RCM unit. The firm’s solutions address admissions, cash collections, A/R days and more. The Claro Group focuses on hospital clients ranging from academic medical centers to community hospitals.
Cognizant (Teaneck, N.J.). Cognizant offers providers a comprehensive suite of revenue cycle management solutions, from patient access platforms to contract management tools. TriZetto, a subsidiary nestled within Cognizant’s healthcare arm, develops health IT platforms to improve revenue cycle operations for Cognizant’s provider and payer clients.
Coker Group (Alpharetta, Ga.). Coker Group, a national healthcare advisory firm, offers a wide range of services from accountable care organization preparation to executive search capabilities. The firm also offers healthcare-specific revenue cycle support including revenue cycle staffing, pay mix analysis, national benchmarking, processes review and more.
Conifer Health Solutions (Frisco, Texas). Conifer, a subsidiary of Tenet Healthcare, has more than 13,000 employees and processes more than $26 billion in net revenue each year. The company, which has 20 service locations through the country, caters to hospitals and health systems, physician groups and employers. Conifer offers revenue cycle management services such as scheduling, eligibility and enrollment, denials prevention, patient financial services and revenue cycle operations management to both the hospital and physician markets.
Connance (Waltham, Mass.). Connace is a healthcare predictive analytics platform. The company’s platform aims to eliminate 20 percent to 30 percent of the work associated with revenue cycle management. Services the platform can provide include vendor performance, self-pay segmentation, claims optimization, revenue optimization and more.
Convergent (Atlanta). Convergent is a process outsourcing, revenue cycle and receivables management company with 14 locations in North America. The company’s revenue cycle management offerings include patient access services, third party reimbursement services, self-pay services and bad debt services.
The Corridor Group (Overland Park, Kan.). The Corridor Group has served more than 2,000 clients, including hospitals and health systems, since 1989. The company offers consulting services, regulatory compliance support, ICD-10 solutions and more. In January, the company acquired revenue cycle management company Healthcare Management Solutions, which expands the company’s revenue cycle management services portfolio.
Craneware (Atlanta). Craneware offers patient access, charge capture and pricing, coding integrity, revenue recovery and retention, professional services and ICD-10 solutions. The company’s automated revenue cycle solution wasnamed No. 1 for the 2015/2016 Best in KLAS Awards: Software and Services. Additionally, the company’s Chargemaster Toolkit ranked first in the “revenue cycle — chargemaster management” category.
Crowe Horwath (Chicago). Crowe Horwath is a public account, consulting and technology firm serving multiple industries. The firm’s healthcare division offers finance, revenue cycle, reimbursement, tax, risk and compliance, audit and mergers and acquisitions services. Crow Horwath’s revenue cycle management program includes credit balance management, denials management, observations services and outpatient charge capture.
Dell (Round Rock, Texas). Dell Healthcare Solutions serves hospitals, health systems, physician practices and health plans. The company provides business process outsourcing, including revenue cycle management. Dell can take on coding, remittance processing, accounts receivable follow-up and denial analysis for its clients.
drchrono (Mountain View, Calif.). drchrono offers a number of services include an EHR, medical billing and a platform for patients to view their health record. The company’s revenue cycle solutions include Apollo and Apollo+. Apollo allows drchrono EHR users to manage billing from the EHR, while Apollo+ gives users access to the company’s fully managed billing services.
Experian Health (Austin, Texas). Experian is a global information services company with a focus on data and analytics. The company’s revenue cycle services can automate up to 80 percent of processes. Its services suite includes patient access, claims, contract management and collections products.
FTI Consulting (Chicago). FTI Consulting serves multiple industries, including healthcare. The consulting firm’s revenue cycle division offers a wide range of services including benchmarking, cash flow performance improvement, managed care contracting, denial management improvement and more.
G4 HealthSystems (Tulsa, Okla.). G4 HealthSystems provides healthcare technology solutions for claims billing and management, audit appeals and management, denial management, work flow, patient statements, patient estimates, payer tracking, clearinghouse services, eligibility verification and more. More than half the company’s clients, 51 percent, are hospitals. Forty-seven percent of its clients are physicians and 2 percent are specialty clients. The company has had 100 percent client retention for three-plus years.
GeBBS Healthcare Solutions (Marina del Rey, Calif.). GeBBS offers HIM solutions, insurance billing services, patient access solutions and end-to-end RCM solutions. The company has a number of technology platforms supporting its services. Technology includes the enterprise-wide coding solution iCode, coding compliance platform iCode Assurance, business process management tool iP2P and EOB to ERA conversion tool iERA.
GE Healthcare (Little Chalfont, United Kingdom). GE Healthcare, a subsidiary of General Electric, offers a wide range of services including revenue cycle management. GE Healthcare provides software solutions for full revenue cycle management support, billing support, analytics and more. The company’s RCM software systems include Centricity Business, Centricity Group Management, Centricity Practice Solution and Centricity EDI.
Global Healthcare Alliance (Houston). Global Healthcare Alliance is a full-service, revenue cycle management company. Its offerings include a medical billing and collection outsourcing solution to physician practices, medical practice management software and bundled payments administration. Global Healthcare Alliance has three decades of experience and has operated as both a payer and provider.
Greenway Health (Carrolton, Ga.). Greenway offers a wide array of solutions for the healthcare industry, including revenue cycle management. The Greenway suite of RCM solutions includes claims management, secondary claim filing, denial management and more. The company’s clients have a more than 99 percent claims acceptance rate and an average decrease of 31 percent in A/R days.
Halley Consulting Group (Westerville, Ohio). Halley Consulting Group offers consulting services exclusively to the healthcare industry. The group’s revenue cycle division offers services including the creation of a revenue cycle management work group, documentation improvement, best practice education, transitioning central billing to central processing, establishing accountability standards and more.
Harmony Healthcare (Tampa, Fla.). Harmony provides revenue cycle management staffing, coding support, HIM leadership, ICD-10 support, HIM offshore services and more. The company offers temporary, temporary-to-permanent and permanent staffing solutions. Harmony has worked with a number of healthcare providers including Ascension Healthcare based in St. Louis, John’s Hopkins based in Baltimore, Yale-New Haven (Conn) Hospital and more.
Hayes Management Consulting (Newton Center, Mass.). Hayes Management Consulting focuses on partnering with healthcare organizations to streamline operations, improve revenue cycle management and enhance technology. The company’s revenue cycle consulting services include assessment, optimization and interim management.
Healthcare Business Insights (Milwaukee). Healthcare Business Insight’s core focuses are revenue cycle, supply chain, cost and quality and information technology. HBI’s Revenue Cycle Academy addresses each element of revenue cycle management. The academy is designed to be a collection of best practice resources to support healthcare revenue cycle leaders.
Healthcare Resource Group (Spokane Valley, Wash.). HRG focuses on providing the healthcare industry a full suite of revenue cycle management services. Services include business office outsourcing, revenue cycle department management, consulting and staffing.
HGS (Lisle, Ill.). HGS has a wide range of services including claims benefit management, medical cost management, revenue cycle management and more. The company’s revenue cycle offerings include patient access support, patient financial services and health information management, as well as technologies designed to support various RCM functions. HGS manages more than $6.9 billion in client accounts receivables. The company has processed more than 60 million claims for hospitals, physicians and other clients.
Human Arc (Cleveland). Human Arc, founded in 1984, provides hospitals and health plans with revenue cycle services with a focus on eligibility determination and program enrollment. The company offers a number of technology services, such as its business-wide information management system COMPASS or its IQualify web-based tools designed for hospital patient financial counselors.
Huron Consulting Group (Chicago). Huron Consulting Group offers a specific healthcare revenue cycle solution. The solution aims to provide an annual 3 percent to 6 percent increase in revenue. Bruce Lemon serves as the managing director of the group’s revenue cycle service. Huron’s healthcare division also offers Epic implementation and optimization services.
IMMI (Las Vegas). IMMI has been offering billing and collections services for more than 20 years. The company days has just 8 percent A/R days more than 90. In addition to its billing and collections offerings, IMMI has consulting, credentialing, financial services and scheduling services.
Impact Advisors (Naperville, Ill.). Impact Advisors is a healthcare consulting firm offering expertise in a broad range of areas, including strategic IT planning, clinical optimization, meaningful use, revenue cycle management and more. The company’s RCM optimization services include patient access, charge services, case management, health information management and patient financial services. In the 2015/2016 Best in KLAS rankings, Impact Advisors wasnamed the Best in KLAS Overall IT Services Firm and the top firm in the IT Advisory Services market segment.
Intermedix (Fort Lauderdale, Fla.). Intermedix is a technology and analytics company serving the healthcare, business and government sectors. Under the umbrella of its healthcare offerings, the company provides EMS revenue cycle management services. Additionally, the company offers RCM services for hospitalists, anesthesiologists and primary care providers. Intermedix handles coding and billing services for more than 12,000 providers.
Jacobus Consulting (Irvine, Calif.). Jacobus Consulting bases its revenue cycle management services on the core areas of patient access, case management, revenue integrity/charge capture, health information management and business office performance improvement. The consulting group also offers interim leadership for revenue cycle leadership roles.
Kaufman Hall (Chicago). The healthcare management and consulting experts at Kaufman Hall help healthcare providers across the country realize improvements in their revenue cycle operations. Kaufman Hall provides hospitals and health systems with a variety of resources to assess revenue cycle performance, pinpoint pain points and devise and implement solutions and processes that drive efficiency.
KeyBank (Cleveland). KeyBank’s healthcare solutions are utilized by more than 10,000 healthcare organizations. The bank’s KeyPatient POS is designed to streamline collections, reduce bad debt, decrease days in accounts receivable and more. KeyBank also offers a payment management solution design to track financial performance and overall improve revenue cycle management processes.
Kraft Healthcare Consulting (Nashville, Tenn.). Kraft Healthcare Consulting, a part of KraftCPAs, includes reimbursement and operations insight, coding and compliance support and advisory services. Within these categories the consulting firm targets revenue cycle management, coding and documentation, ICD-10 preparation, underpayment recovery and more.
Leidos (Reston, Va.). Leidos focuses on national security, engineering and health. The company employs 19,000 people worldwide. Leidos Health’s revenue cycle solutions are designed for assessment and optimization. The company focuses on patient access, revenue integrity and patient financial services. Leidos Health also lends support in the form of interim leadership, initiative support and project management.
McKesson (San Francisco). McKesson offers healthcare providers revenue cycle management optimizations services, as well as several products. The company’s service portfolio includes access management improvement, healthcare consumerism support, cash collection acceleration and payer performance improvement. McKesson’s revenue cycle management product portfolio includes solutions for medical billing and revenue cycle management, the McKesson Performance Analytics system, McKesson Intelligent Coding and Paragon Hospital Information System.
MedAssets (Alpharetta, Ga.). MedAssets has solutions driven toward reducing the cost of care, enhancing efficiency, aligning clinical delivery and improving revenue performance. The company’s revenue cycle management solutions are driven to reduce total cost by approximately 10 percent and increase net revenue by up to 5 percent. MedAssets provides revenue performance improvement consulting for all RCM processes, as well as ICD-10 readiness services.
MedAssist Healthcare Solutions (Louisville, Ky.). MedAssist is a patient engagement company focused on revenue cycle solutions. The company services more than 700 hospitals and health systems. MedAssist’s revenue cycle solutions include several patient access technologies, such as a patient bill estimator, and several business office services, such as denial management and tracking.
MedData (Brecksville, Ohio). MedData has been around for more than 36 years. The company offers various technology-enabled healthcare services. These services include billing, coding, patient balances, eligibility and enrollment, third party liability and patient satisfaction. MedData has a network of more than 1,000 hospital sites nationwide.
MedeAnalytics (Emeryville, Calif.). MedeAnalytics’ services are tailored for both healthcare providers and health plans. The company’s revenue cycle offerings aim to accelerate cash flow, limit bad debt and denials, automate collections workflow, evaluate service line profitability and streamline monthly reserves. MedeAnalytics also offers ICD-10 and patient access solutions.
MedHelp (Baltimore). MedHelp offers several revenue cycle management services including professional fee billing, physician billing and credentialing services. The company specializes in emergency department MCO denial appeals. Additionally, the company developed an internal scrubbing program that allows for expanded medical coding review and scrubbing.
MediGain (Dallas). In 2002, MediGain broke into the healthcare market as a full-service revenue cycle management company. The firm provides revenue cycle management, medical billing and reimbursement services and solutions to physicians practices, ambulatory surgical centers and hospitals. Since its founding, MediGain has grown into a global company with an integrated portfolio of IT and process solutions.
MediRevv (Coralville, Iowa). MediRevv specializes in helping hospitals, health systems, academic medical centers and physician groups improve their cash flow and grow their revenue. The company offers self pay and insurance extended business office services, coding and denials management services and more. The company has clients such as Bon Secours Health System, based in Richmond, Va., and Dignity Health, based in San Francisco.
MEDITECH (Westwood, Mass.). Health IT vendor MEDITECH’s revenue cycle management solution offers automated claim tracking, denial management, integrated charge capture and more. The solution offers support for centralized and decentralized billing. MEDITECH’s RCM offering is designed to provide integration between hospital and office settings and to consolidate all revenue cycle functions.
MedSynergies (Irving, Texas). MedSynergies, acquired by Optum last year, offers healthcare providers financial and operational insight and support. The company’s product MSIGHT helps providers streamline revenue cycle processes from appointment scheduling all the way through to patient check out.
Meridian Medical Management (Windsor, Conn.). Meridian Medical Management services more than 40,000 healthcare providers each year and processes more than $5 billion in revenue for medical practices. The company was acquired by GE Healthcare in 2005, but reestablished as a private entity. The company provides medical billing services on a number of different platforms, such as Allscripts, eClinicalWorks, GE Centricity, NextGen EPM and VertexDr. Additionally, Meridian Medical Management will operate on the Epic platform for its academic medical center clients.
MiraMed Global Services (Jackson, Mich.). MiraMed began as a small practice management company in 1979 and grew into a large-scale healthcare business process outsourcing provider. The company offers hospitals and physicians patient services, billing services and reimbursement solutions, as well as practice management and consulting options.
National Medical Billing Services (Grover, Mo.). NMBS is a revenue cycle outsourcing company catering specifically to the ambulatory surgery center market. The company offers a full suite of revenue cycle solutions including complete outsourcing, coding, coding and billing audits and managed care contracting.
Navicure (Duluth, Ga.). Navicure’s portfolio includes cloud-based healthcare claims management and patient payment solutions. The company has several product lines tailored for specific RCM functions. Naviure ClaimFlow includes solutions for eligibility verification, coding, claims management, remittance management and denials and appeals management. All of the company’s solutions are backed by its 3-Ring Client Service, which guarantees a service representative will answer each client call in three rings or less.
Navigant Cymetrix (Irvine, Calif.). Navigant Cymetrix, a fully-owned subsidiary of Navigant Consulting, was formed this year by the consolidation of Alleviant, Cymetrix and legacy RCM businesses. Navigant Cymetrix provides comprehensive RCM services, consulting services, eligibility and financial counseling, self-pay services, clinical documentation integrity, coding support and auditing, payment processing, accounts receivable management and more.
NaviNet (Boston). NaviNet is a healthcare communications network designed to facilitate payer and provider collaboration. NaviNet has more than 40 health plan partners and 420,000 active users. NaviNet’s revenue cycle resource focuses on determining patients’ out-of-pocket costs. The group’s Payment Estimator allows providers to verify eligibility and providers an accurate estimate of a patient’s financial responsibility.
Nearterm (Houston). Nearterm offers interim management, healthcare executive search capabilities, project staffing and revenue cycle consulting. The company’s core RCM offering is Nearterm 360°. The solution incorporates health information management, consulting, permanent executive search and temporary staffing.
NextGen Healthcare (Horsham, Penn.). NextGen Healthcare offers ambulatory solutions, population health management, interoperability solutions, consulting solutions, revenue cycle management and more. The company’s revenue cycle division offers consulting and outsourcing for physician billing, collections and claims. NextGen Healthcare’s revenue cycle management services are driven by technology and proprietary solutions.
Nordic (Madison, Wis.). Nordic is a healthcare consulting company offering implementation solutions, optimization tools and Epic services. Among its many advisory options, the company offers RCM services. The company focuses on creating revenue cycle efficiencies to maximize charge capture, decrease days in A/R, improve staff productivity and streamline the entire process.
NueMD (Marietta, Ga.). NueMD offers a cloud-based platform that offers healthcare providers practice management services, an EHR and medical billing services. NuedMD’s medical billing software and EHR work together to decrease outstanding claims, provide customized reposts and more. The company’s practice management services aim to reduce patient cancellations and boost claims acceptance.
Ontario Systems (Muncie, Ind.). Ontario Systems is a software and services company focused on the healthcare industry. The company’s product Artiva Healthcare is designed to enhance providers’ patient accounting system. The company also offers Revenue Performance Optimization, a portfolio of consulting services.
Optum 360 (Eden Prairie, Minn.). Optum 360 is a patient-focused revenue cycle management service provider for hospitals and physicians. Services include revenue cycle management consulting, health IT and systems, medical coding and documentation, claims and reimbursement, denial management and recovery, financial compliance, ICD-10 readiness and more.
Parallon (Franklin, Tenn.). Parallon offers revenue cycle management insight and customized solutions. The company, which employs 14,500 plus people, is partnered with more than 700 facilities and 6,000 physician practices. Parallon offers full-service revenue cycle outsourcing, consulting, payment compliance, collections, physician billing, extended business office services and more.
Patientco (Atlanta). Patientco focuses directly on the revenue cycle portion involving the patient. The company provides a cloud-based, online platform that automates the entire patient payment process. The system is designed up automate up to 80 percent of patient payment tasks, including payment reconciliation and automatically posting files to health information and practice management systems.
Physicians Group Management (Lyndhurst, N.J.). PGM, founded in 1981, offers physician billing services, facility billing services and EMR solutions. The company offers billing solutions specifically tailored to a number of different specialties including allergy and immunology, anesthesiology, cardiology, chiropractic, dermatology, emergency medicine, gastroenterology, mental health, nephrology, oncology, orthopedics, pain management, primary care and urology.
PNC Healthcare (Chicago). PNC Healthcare, a division of PNC Bank, offers healthcare providers a number of revenue cycle management resources. PNC Healthcare’s products range from claims submission services and electronic remittance to a patient estimator and denial challenger.
Precyse (Wayne, Pa.). Precyse’s solutions include health information management, medical coding and computer assisted coding, clinical documentation improvement, medical transcription, ICD-10 education and more. That company’s services have been used by more than 4,000 healthcare facilities and providers across the country.
Prism Healthcare Partners (Chicago). Prism offers financial, operational and clinical performance improvement services to hospitals, health systems and academic medical centers. The company’s revenue cycle solutions hone in on identifying any inefficiencies and boosting net revenues. Prism’s solutions include registration, insurance verification, financial counseling, charge capture, coding, collections, managed care contracting, clinical documentation and more.
PwC (New York). PricewaterhouseCoopers, a large business intelligence consulting firm, has consulting services for a wide range of areas, such as strategy, operations, risk and finance. PwC’s revenue cycle services are offered through its financial management branch. Its core offering is its Virtual Business Office, which serves as an extension of clients’ physician business office. The VBO offers third-party aged accounts receivable remediation, insurance verification, claims volume management, customer service support and more.
Quadax (Middleburg Heights, Ohio). Quadax has revenue cycle solutions customized for hospitals, physician practices, vendors and laboratories. The company’s line of solutions aims to increase cash flow, maximize productivity and reduce paper processing dependency. Quadax specializes in electronic transaction management, emergency department business services and laboratory revenue cycle management.
Quest Diagnostics (Madison, N.J.). Quest Diagnostics is a clinical laboratory services company. The company, along with Inovalon, offers a Data Diagnostics solution, which provides physicians with real-time analytics at the point of care to improve value-based care efforts. Data Diagnostics provides patient-specific analyses that help physicians align clinical management strategies with quality, utilization, risk and financial performance goals in the pursuit of value-based care. The data solution is integrated with nearly 600 EHR platforms.
Quorum Health Resources (Brentwood, Tenn.). QHR, founded in 1977, offers a number of brands including QHR Management Services, QHR Consulting Services, Quorum Purchasing Advantage and The QHR Learning Institute. The company’s revenue cycle solution focuses on providing cash flow solutions from coding and billing to patient access and customer service.
Recondo Technology (Greenwood Village, Colo.). Recondo Technology aims to connect providers, patients and payers with cloud-based revenue cycle management solutions. Recondo’s patient access services included integrated payer authorization, accurate patient estimation, analytics-driven denial avoidance and more. The company’s business office portfolio includes automated claims workflow, claims status data, denial management, claims submission and more.
Regent Revenue Cycle Management (Westchester, Ill.). Regent RCM is an independent division of ambulatory surgery center management and development company Regent Surgical Health. The company offers billers and collectors with an average of more than 17 years of revenue cycle management each. The company offers a number of automated services including insurance verification, electronic claims processing, electronic payer payments and patient remittance posting, digitally stored contracts, outsourced patient statement generation and report formatting.
RelayHealth (Emeryville, Calif.). RelayHealth, owned by McKesson, offers analytics-driven revenue cycle management solutions. The company’s products include RelayAnalytics Acuity, RelayAnalytics Pulse and RelayAnalytics Spectrum. The Acuity product focuses on providing data to support decisions in areas ranging from ICD-10 compliance to reimbursement. The Pulse product helps create meaningful benchmarks. The Spectrum product is an iPad application designed to allow mobile access to data.
RSM US LLP (Chicago). RSM US offers advisory services to several industries, including healthcare. The firm’s revenue cycle services suite includes research and management reports, supporting analytics, performance indicator summaries, executive presentations to leadership and more.
re|solution (Louisville, Colo.). re|solution offers services for the full range of revenue cycle processes. Services include a revenue improvement program, cash acceleration, days in accounts receivable reduction, interim staffing, business office insourcing and coding and compliance services.
RevClaims (Jackson, Miss.). RevClaims focuses on injury claims billing. The company partners with providers to increase claims recovery related to workers’ compensation, automobile accidents and catastrophic injuries. The company works with hospitals, health systems and trauma centers.
RevenueXL (Cupterino, Calif.). RevenueXL is a healthcare solutions and EMR company focused on small- to mid-sized practices. The company not only provides EMR and EHR solutions, but also medical transcription, coding compliance and document indexing. RevenueXL’s medical billing portfolio also includes billing software options, billing services, coding services, insurance follow up and denial management.
RevSpring (Wixom, Mich.). RevSpring focuses on customized revenue cycle solutions. The company offers business process outsourcing. RevSpring applies data analytics, patient centered communications and more to improve providers’ revenue cycle processes.
RPM Healthcare (Charleston, S.C.). RPM focuses on delivering customized solutions to help healthcare organizations keep their revenue cycles healthy in a rapidly changing reimbursement environment. The company considers an organization’s particular payer mix, specialties and demographic environment to create operational and management solutions that drive RCM improvement.
Rycan (Minneapolis). Rycan, recently acquired by Healthland, is a healthcare revenue cycle software company. Rycan’s solutions address revenue cycle issues including patient liability, eligibility verification, claim submission, remittance management, denial management, contract management, reporting and data mining and more.
SCI Solutions (Campbell, Calif.). SCI Solutions provides business process software for more than 550 hospitals, imaging centers, physician practices and post-acute care providers. SCI Solutions offers the Provider Network Manager that is designed to boost outpatient volumes, referrals and revenues. The company also offers a scheduling platform and client performance optimization services.
SourceMed (Birmingham, AL). SourceMed solutions capture, exchange and analyze data that that enable outpatient facilities to optimize revenue, increase operational efficiency and improve compliance. The company’s integrated software, analytics, revenue cycle management and professional services are used by more than 35,000 healthcare professionals in over 6,500 ambulatory surgery centers, specialty hospitals and rehabilitation therapy clinics nationwide. SourceMed’s team of certified coders, billers and collectors ensures that claims are continually worked so that customers realize earned revenue more quickly and stay compliant with changing regulations.
Specialty Billing Solutions (Lakewood, Colorado). Specialty Billing Solutions, a wholly owned subsidiary of ASC management company PINNACLE III, provides coding, claims submission, denial management and patient financial services for ambulatory surgery centers. The company’s team includes certified professional coders, experienced billing & collection professionals and is 100 percent United States-based. The company performs “forensic collections” on new client accounts with existing A/R to capture proper reimbursement for old claims. ASCs making the switch to Specialty Billing Solutions have realized increases in net revenue per case of at least 10 percent.
The SSI Group (Mobile, Ala.). SSI focuses on claims management technology and electronic data interchange platforms. The company’s financial performance service options include denial management, audit management, contract management, analytics and SSI Medibis. Medibis is a solution designed for the ambulatory surgery center market. SSI’s claims management service portfolio includes billing, claims status and the Cerner HIS Solution.
SymMetric Revenue Solutions (Fort Meyers, Fla.). SyMetric Revenue Solutions offers a diverse services suite ranging from revenue cycle management and physician practice management to real-time reporting and value-based medicine. The company’s revenue cycle options include emergency department coding and billing, hospitalist coding and billing, urgent care coding and billing, documentation improvement, auditing, collections and more.
TD Bank (Toronto, Ontario). TD Bank’s healthcare and not-for-profit banking group offers liquidity solutions and financing solutions in addition to revenue cycle management. TD Healthcare Remittance Management offers a comprehensive solution for healthcare revenue cycle management processes.
Trace by The White Stone Group (Knoxville, Tenn.). Trace is a communication management solution designed to support scheduling, coordination and reimbursement functions. The system offers revenue protection, enhanced communication, compliance support and operational performance enhancement.
TransUnion (Chicago). TransUnion provides solutions for several industries including healthcare. The company’s revenue cycle solutions serve both hospitals and physician practices. TransUnion’s revenue cycle management services and technologies focus on patient access, reimbursement and data breaches.
TSI (Lake Forest, Ill.). With a focus on compliance, TSI, formerly Transworld Systems, aims to ensure clients, patients and their data are protected. The company’s revenue cycle solution MDeverywhere aims to streamline hospital and physician practice revenue cycle management processes. The MDeverywhere system includes practice management software, a claim expert, a contract expert and business services. The system decreases denials up to 90 percent.
TruBridge (Mobile, Ala.). TruBridge is a business and IT services consulting company focused on rural and community hospitals. The company’s revenue cycle management services include accounts receivable management, private pay collections, insurance follow-up, contract management, statement processing, online bill pay and medical coding.
United Collection Bureau (Toledo, Ohio). UCB, founded in 1959, provides revenue cycle services to more than 400 healthcare providers. UCB’s revenue cycle solutions include pre-registration services, eligibility assistance, presumptive charity, pay analytics, self-pay collections, insurance follow-up and bad debt recovery.
VisiQuate (Santa Rosa, Calif.). VisQuate offers a number of products including an enterprise performance management platform, visual operating system, business analytics engine, knowledge distribution engine, business rules management and data integration studio. In 2014, VisiQuate partnered with Ovation Revenue Cycle Services to offer its healthcare clients a combination of revenue cycle software and services.
VitalWare (Yakima, Wash.). VitalWare offers RCM services and tools powered by cloud-based technologies, identifying and simplifying challenges in an ever changing and regulated industry. The company offers best in class documentation, coding, billing and auditing services for a powerful user experience. VitalWare’s products include VitalCDI, iDocuMint, VitalCoder, VitalCDM, VitalCharges and VitalAuditor.
VHC (Oakbrook Terrace, Ill.). Vaughn Holland Consulting focuses on revenue cycle consulting. The firm’s services include revenue recovery, Medicare underpayments, software solutions, health information management solutions, revenue cycle consulting and more.
Xifin (San Diego, Calif.). In 2001, health IT technology company Xifin launched an accounts receivable and financial management solution aimed at using a financial framework specifically to address the problems that undermine the effectiveness and efficiency of laboratories’ revenue cycle management. Today, the company’s billing solutions service diagnostic service providers of all types — including clinical, hospital outreach, anatomic pathology, molecular diagnostics, toxicology and radiology providers. XIFIN processes more than 200 million claims annually on behalf of its clients, and has realized over $2 billion in cumulative net cash collection gains for them.
Xtend Healthcare (Hendersonville, Tenn.). Xtend Healthcare focuses on financial performance improvement. The company aims to improve revenue cycle functions, offers staff extension and IT assets and focuses on bottom line improvements. The company’s revenue cycle management solutions include on-site accelerated recovery, extended business office services, automated follow-up, consultation, HIM consulting, coding services, ICD-10 education and self-pay services.
ZirMed (Louisville, Ky.). ZirMed, founded in 1999, provides services to more than 8,000 healthcare organizations and nearly 300,000 providers. The company’s key service offerings are patient access, charge integrity claims and accounts receivable management, cost and utilization, population risk management and patient engagement.
Zotec Partners (Carmel, Ind.). Zotec is a specialty-driven company with a focus on anesthesiology, emergency medicine, pathology and radiology. The company’s medical billing services include customized billing protocols, contract variance, integrated imaging, a patient portal, automated appeals and more.