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 billing solution can make a difference. CRYPTON’s powerful health system revenue cycle management solutions allow you to coordinate efforts across multiple settings to gain a big picture view of overall performance. Take your health system’s revenue cycle management (RCM) to the next level with CRYPTON’s powerful billing solutions that drive dollars to your bottom line and help you stay competitive.

Want to learn more? Take a tour of CRYPTON’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 are 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. CRYPTON’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 CRYPTON can help:

Contract Management

Is your payer contract reimbursement at risk? Cumbersome contract loading and management can leave you out of sync with new contract terms and conditions exposing your health system to the risk of underpayments and declining revenues. IT and staffing constraints can also make it difficult for timely payer contract modeling placing your negotiations on unequal footing and in danger of adverse financial consequences.

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 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. CRYPTON’s insurance verification products include an RCM solution 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 CRYPTON can help:

Eligibility Verification

Ineligible patient insurance coverage is one of the leading causes of payer claim rejections and denials. CRYPTON’s Eligibility Verification solution provides customizable and easy-to-read payer responses. Beyond insurance eligibility verification, CRYPTON includes co-pays, deductibles, inpatient days used, and other pertinent benefit data. Armed with this information, you’ll be able to make payment arrangements and increase collections prior to rendering services.

Coverage Detection

A surprising percentage of your self-pay and charity patients likely have full or partial insurance coverage that your organization may not be aware of. CRYPTON’s Coverage Detection solution provides powerful, proprietary intelligence based on a decade of data from hospitals, health systems, physicians, specialty groups, ancillary providers, and payers.

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 CRYPTON can help:

POS Collections and Processing

High-deductible health plans and self-pay patients make patient financial responsibility a key part of your revenue stream. Not only must you collect more money directly from your patients than ever before, but you also need to keep them happy while you’re doing it. That’s the only way to build patient satisfaction and loyalty.

Patient Notebook

Today’s consumers want the convenience and ease of paying their bills online, and that desire doesn’t change when those consumers become patients. CRYPTON’s Patient Notebook, a patient payment portal, provides a secure online patient payment center where you can send statements, collect payments, and more via a secure and safe channel.

Patient Statements and Communication

Patients often delay paying their healthcare bills — or refuse to pay them at all — simply because they don’t understand what they owe and why. These bills may take hours of staff time to create, fold, stamp, and address, not to mention the cost of postage and returned mail. With CRYPTON’s Patient Statements, you can design, create, and send patient statements that are easy for patients to understand and that drive reimbursement to your preferred payment options.

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. Here’s how CRYPTON can help:

Charge Integrity

Hospitals and health systems lose an estimated 1% of net revenue annually due to an inability to identify claim coding errors that contribute to charge capture leakage. CRYPTON’s Charge Integrity solutions automate the discovery of hidden revenue opportunities and overcharges to ensure your staff can proactively correct claim errors for accurate reimbursement and coding compliance.

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 cash flow 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 CRYPTON’s claims management solutions make it easy to manage both institutional and professional claims for the entire health system. Here’s how CRYPTON can help:

Claims Management

Filing claims and collecting payments from commercial and government payers is the financial lifeblood of your organization. Powered by insights drawn from CRYPTON’s network of thousands of providers and organizations, our claims management services streamlines and automates your entire workflow for faster and more accurate medical claims processing, lower costs, and higher efficiency.

Payment Analytics

Optimal revenue performance hinges on constantly monitoring key performance indicators (KPIs) and acting decisively to address issues before they significantly impact your organization.

Denial & Appeal Management

The time-consuming process of denial management—which includes tracking claim adjudication, identifying denied claims, researching reasons for denials, collecting necessary documentation, and writing and submitting appeals – need not be so laborious. CRYPTON’s Denial and Appeal Management solution reduces the time spent researching the denial and appealing each claim by so that you can invest your more on patient rather than denial management.

Remit Management

Lost claim remittances and the time-consuming process of manually posting payments leads to costly delays, increased AR days, and unrealized revenue. CRYPTON’s Remit Management solution provides a cost-effective way to receive electronic remittance advice from payers and compile the information all in one system, saving you time and reducing manual processes and errors.

Remit and Deposit Management

Historically, reimbursement deposit management has been mostly a manual and time-consuming process, requiring providers to wait for each bank statement to arrive and manually reconcile each remit. Re-association takes multiple resources, and missing deposits or remits can take hours to resolve. CRYPTON’s Remit and Deposit Management solution provides up-to-date banking information so you can quickly and accurately post payments. The solution automates the remit and deposit management process by offering a direct connection to a provider’s banking accounts to save time, reduce days in accounts receivable, and improve cash flow.

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. CRYPTON’s denial management solutions include analytics and reporting capabilities help you understand overall system performance and areas of vulnerabilities. Here’s how CRYPTON can help:

Denial Avoidance

CRYPTON’s Denial Avoidance solution combines people, process, and technology to drive denial prevention and identify the root causes of denials throughout the revenue cycle. By leveraging denial prediction technology, advanced analytics, and proprietary advisory services, CRYPTON’s Denial Avoidance services unlocks patterns and problematic attributes within your denial population.