Key Considerations For Choosing a Revenue Cycle Technology Vendor

January 10, 2024 - Revenue cycle technology is not one size fits all. Whether a solution promises to ease patient collection woes or streamline claims management processes, healthcare providers must do their due diligence to select the revenue cycle technology and vendor that meets their specific needs and workflows.

Sherri Lewis, the director of revenue cycle management at BoulderCentre for Orthopedics & Spine, knows this all too well. Her practice has partnered with revenue cycle technology vendors that have aligned with their mission and improved operations and others who have not.

As a growing practice of about 20 providers performing orthopedic surgeries, the revenue cycle must run smoothly to support the BoulderCentre for Orthopedics & Spine’s mission.

“Our goal is to provide care to our patients,” says Lewis. “They shouldn't be worried about a prior authorization and things like that, and we shouldn't be worried either. Caring for our patients is the number one priority, but we're a privately held company, so we need to have revenue and get paid for our procedures and care. You have to make sure your processes are working.”

Lewis now understands what to look for when making a revenue cycle technology decision, including how to find a vendor who partners with the practice to ensure success.

Return on investment

Ensuring a return on investment (ROI) in technology is top of mind for revenue cycle leaders facing significant headwinds from reimbursement cuts, higher operating costs, and a shrinking talent pool.

“We are having a difficult time finding employees and keeping them here,” Lewis states, referencing a trend felt by healthcare practices of all specialties across the country. “I don’t know where they all went, but the ones who are here want to work remotely, and we have had a hard time with that. We’ve looked to find technology that will help us with our lack of employees.”

Revenue cycle technology can bridge the gap between the shortage of skilled professionals in an area and a practice’s need for an efficient revenue cycle. Vendors now offer solutions to automate prior authorizations, leverage artificial intelligence to manage denials, and more. These solutions can take some of the more tedious, manual tasks from humans, leaving employees to focus on value-adding revenue cycle activities.

However, practice leaders need to ensure that these technologies do not add to the employee burden.

“With one vendor, it’s like we are paying for two employees for the service, so we aren’t really seeing a return on investment,” Lewis explains. This particular solution did not align with BoulderCentre for Orthopedics & Spine’s needs, resulting in poor integration with the practice management system and lackluster customer service (two other key considerations for Lewis).

In contrast, BoulderCentre for Orthopedics & Spine is seeing a 3,000 percent ROI from a Rivet solution providing real-time eligibility verification and patient communications. The solution automated a manual workflow requiring a full-time employee to manage, leaving that person to collect payments from patients prior to appointments or when automated attempts have failed.

BoulderCentre for Orthopedics & Spine has renewed its contract with Rivet because of ROI and several other positive factors that have made its provider-vendor relationship more of a partnership.

Customer service

To err is human, but even technology can’t always get it right. That’s why comprehensive, readily available customer service is key to a successful partnership with a revenue cycle technology vendor.

“When I’m using a system that interfaces with our system, if I’m having a problem, I like an immediate chat or the ability to access someone to help immediately,” Lewis says. “One company I’ve used, I had to send an email and they would get on it, but it wasn’t immediate.”

However, with BoulderCentre for Orthopedics & Spine’s more successful contracts, Lewis knows the customer service representatives who manage their feedback. Responses from the customer service team are also in real time via chat or through a dedicated account manager. Manuals can only get revenue cycle leaders so far, suggests Lewis, who has worked with vendors who have requested she look at the manual first to troubleshoot problems.

“It’s very important to have someone to work out the bugs, and not just an onboarding manager,” Lewis adds. “Onboarding managers eventually disappear and you’re left with the product. You need people to speak to.”

Lewis also values vendors who welcome feedback and recommendations from their provider partners.

“I like being able to make suggestions to a software company,” Lewis explains. “Sometimes, I can see how the software could really enhance our workflows if it was able to do something else. Meanwhile, another company [that doesn’t work as well for the practice] is not even flowing yet, let alone making enhancements. Good product development is key.”

Practice management integration

Integration is a common area that causes problems for providers implementing and using revenue cycle technology effectively. Revenue cycle technology should ideally integrate with a practice’s existing IT infrastructure to enable a seamless flow of data and proper workflows. Integration with an organization’s practice management system is especially vital.

Lewis describes an experience with a revenue cycle technology vendor as a lesson learned after implementing the solution and it did not interface with BoulderCentre for Orthopedics & Spine’s practice management system from athenahealth.

“I wish I would have checked references with the company we onboarded with because now I’m asking them repeatedly for other customers that use the athena system to see if they have the same workflow issue or if they found a solution,” Lewis shares. “I haven’t received a contact and I’ve been directed to put a ticket in with our practice management system, so it hasn’t worked well for us.”

Changing a practice management system is a major decision that most providers will avoid. So, revenue cycle technology needs to integrate with a practice’s existing system to work effectively and generate ROI.

“You should check with your practice management software and make sure they work seamlessly with whoever you’re trying to interface with,” Lewis suggests.

 Security and compliance

Healthcare providers must always verify the security and compliance components of any technology they adopt; revenue cycle technology is no exception.

Ensuring a vendor has a good track record of maintaining patient privacy and data security, as well as compliance with HIPAA and other healthcare-related regulations is vital to the success of a technology. Providers should also assess vendors' compliance with financial rules and regulations if they handle sensitive payment information.

“We look at if a company has had security breaches in the past,” Lewis says.

Checking a vendor’s security past is a major component of a practice’s third-party risk management strategy. Third-party risk management, or vendor risk management, is the due diligence providers perform to ensure partners do not elevate their risk of a potential security event.

Providers, in general, should perform risk management prior to signing a contract and regularly audit their partnerships after that. These assessments may include verifying encryption methods, access controls, and incident response plans.

Providers cannot afford a security event or revenue leakage, whether they belong to a small practice or a major health system. Economic headwinds continue to impact operations, leading to higher costs. Revenue cycle technology can help organizations move forward and increase efficiency, but leaders need to find the right partners. Otherwise, providers are stuck in a contract with a vendor that does not align with their mission.

“Evolving is really key, and having a software interface that’s able to grow with you and share in your vision of what’s coming is vital,” Lewis says. “Take to people at the vendor and find out what they see and want. That’s key.”