Healthcare Revenue Cycle Management

Achieve High-Efficiency, Error-Free Revenue Cycle Management

The Challenge: Healthcare providers are under tremendous pressure to streamline the revenue cycle. With the need to meet reform mandates, cut cycle times and reduce errors, these organizations must find solutions that dramatically increase the percentage of clean bills generated at first issuance and shrink the time and effort required to collect payments.

Unlike legacy applications that focus on resolution at the end stages of the revenue cycle or point solutions that take limited approaches, Pega’s Revenue Cycle Management solution facilitates automated and streamlined error correction at every stage. With intelligent, real-time processes that augment and extend existing systems, Pega offers transparency at every point in the revenue cycle and immediate response to specific patient account and billing issues so that healthcare providers can substantially reduce time, costs and errors for billing and payment collection.

• Improve the first-pass clean bill rate. Fully automated exceptions management at each stage in the revenue cycle reduces manual tasks and rework.
• Gain a holistic approach to revenue management. Enterprise case management unified with exception management allows organizations to manage patient accounts through the entire revenue cycle from pre-admissions to collections and payment posting.
• Eliminate operational silos. A 360-degree dashboard provides a comprehensive view of revenue cycle workflows for greater visibility, efficient task assignment and rapid hand-offs.
• Enhance compliance. Rules-driven processes dynamically apply best practices to check, correct and translate common billing errors in each stage.

Get the Revenue Cycle Management data sheet.

Customer Success

Increased Billing Accuracy with Real-Time Code Verification This well-known U.S. healthcare provider offers services from coast-to-coast, including hospitals, outpatient centers and corporate and business offices. Building on the success of its initiative to migrate all of its legacy governance, risk and compliance applications to Pega, the provider then implemented a solution to increase billing accuracy and efficiency. Using Pega, the provider now performs real-time coding accuracy checks on patient invoices before creating a claim. As coding staff abstract appropriate procedures and diagnoses codes from medical records, the Pega solution provides instant feedback concerning their decisions to prevent denied or unpaid claims.