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 knowledge can make a difference. Your hospital staff can improve profitability and drive process improvement by using our support services with your existing health information system. With CRYPTON’s support, 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, knowledgeable and experience solutions that help you recoup and retain every dollar to which you’re entitled.

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 CRYPTON’s contact optimization solutions, your staff is empowered to create, maintain, and model contracts for your hospital.

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 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.

Manage payer contracts to favor your hospital financially.

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 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-and-a-half of data from hospitals, health systems, physicians, specialty groups, ancillary providers, and payers.

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 CRYPTON can help:

POS Collections & 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 & 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.

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 CRYPTON can help:

Charge Integrity

Hospitals and health systems lose an estimated 1-5% 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 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 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. 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, we use award-winning claims management software’s, best in the market which 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.

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.

Prevent write-offs and bad debt with denial avoidance.

As much as 13%-15% 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 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 software unlocks patterns and problematic attributes within your denial population.