Healthcare Revenue Cycle Management (RCM) Solutions Powered by Nividous Platform

Increased appointments, Automated Claims Management, and Faster Claim to Cash

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Healthcare Revenue Cycle Management Case Study

  • 3x

    Increase in appointments without increasing call
    37K+

    Hours saved, freeing highly skilled staff
    $16M

    Eligible claims processed and reconciled
    40%

    Faster integration of a new acquisition
    9Day

    Reduction in claim to cash

    A Leading Eyecare Group Revolutionizes its Complete Revenue Cycle Management

    The group provides operational support solutions to 120 optometry practices and they continue to grow through acquisitions. The rapid nature of these acquisitions made it difficult to assimilate all of the incoming information systems, causing critical challenges and risking significant revenue loss. This led them to search for reliable healthcare revenue cycle management solutions. Nividous was selected and deployed as a standardized platform to address these issues, transforming overall healthcare Revenue Cycle Management.

How Nividous Platform Powers Your Revenue Cycle Management Automation

The Nividous Platform-enabled Revenue Cycle Management process allows companies to utilize automation in order to have greater control over collection costs, make data-backed organizational decisions, reduce manual admin functions, increase operational efficiency, and produce positive financial performance across business units.

Revenue Cycle Management initiates when a patient makes an appointment and concludes when a provider receives payment. There are five steps a company must complete once the process begins. These include:

1Verification Of Eligibility
Providers will check insurance eligibility before seeing a patient to verify the parties responsible for payment. For employees, this process is often tedious and involves access to several insurer portals, increasing the risk of errors and rework. With Nividous RPA bots, this process is automated and error-free.
2Medical Coding And Claim Preparation
Providers must assign an accurate code for each service and supply. Providers cannot collect from insurers without providing these codes, so accuracy is paramount. Automating medical coding with a combination of RPA, AI, and BPM — three pillars of the Nividous Hyperautomation platform — typically slashes time-to-cash in half.
3Claim Submission
Providers transmit claims to insurers via online portals. Each insurer operates a separate portal, making coded integrations untenable. Nividous RPA bots operate through user interfaces, allowing providers to automate claim submissions through a diversity of insurer portals.
4Dispute Management
Insurers don’t agree with some claims and reject others. When Revenue Cycle Management is automated through the Nividous platform, companies are able to build in rules to escalate these exceptions to staff, optimizing talent pools for faster resolution and payment.
5Claim Reconciliation
Insurers will transfer funds directly to the provider’s bank account upon the approval of a claim. Staff must then reconcile the payment within complicated financial systems. Nividous AI-enhanced RPA bots can automate this task and eliminate human error.

What Makes the Nividous Revenue Cycle Management Solution Different?

The Nividous platform combines RPA bots, AI capabilities, and a BPM core to achieve full process automation. This allows Nividous to orchestrate the actions of RPA Bots and human employees through a workflow map that assigns tasks and tracks them until complete. The platform uses integrated reporting tools to collect detailed data sets, allowing administrators to continually refine Revenue Cycle Management with real-time visibility.

Key indicators important to Revenue Cycle Management include:

Accounts Receivable

Accounts Receivable

Insurer filing limits usually expire 90 days from the date of service. The Nividous platform ensures timely payment within the industry-standard 30-45 days.
Bad Debt

Bad Debt

Nividous platform-enabled automation helps you improve the effectiveness of your collection efforts and minimize your bad debt rates.
Discharge Not Final Billed [DNFB]

Discharge Not Final Billed [DNFB]

The cost effects of outstanding DNFB accounts and claim denials are staggering. Minimize claim delays and improve cash flow with the Nividous platform.
Net Collections

Net Collections

Improve the efficiency of your overall revenue cycle management process by 85% using Nividous end-to-end automation.
Clean Claim Ratio

Clean Claim Ratio

Boost the average daily claims that pass without revision compared to the total number of claims accepted by 30%. It is a key indicator of claims processing effectiveness.
Document Processing

Document Processing

Nividous’ IDP capabilities, natively built within the platform, can save >$15/hour automating data extraction from patients’ insurance IDs, claims documents, etc.

Benefits of Nividous’ Holistic Approach to Healthcare Revenue Cycle Management

The benefits of automating Revenue Cycle Management in healthcare are numerous. Companies who incorporate the Nividous platform experience boosts in coding accuracy, improvement in clinical documentation, increased charge capture, and better management of compliance risks in order to accelerate reimbursement. Companies are also able to integrate claims management to automate workflows, prevent denials, and accelerate cash flow. This is far superior in comparison to other healthcare revenue management solutions.
  • 45% Improved Claim Adjudication
  • 60% Greater Efficiency For Patient Scheduling
  • 55% Increased Patient Account Settlement
  • 80% Improved Auditing And Compliance
  • 75% Superior Management Of Claims
  • Over 90% Data Extraction Accuracy
  • Up To 50% Faster To Implement
  • Over 85% Reduction In Processing Time
  • 4-6 Months To Realize RoI
  • 5X Lower Total Cost Of Ownership

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FAQs

1What is Revenue Cycle Management in healthcare?
Revenue Cycle Management is the process of securing payment for medical services in the US healthcare industry. It is an end-to-end process that includes, patient registration, scheduling, eligibility verification, medical coding, and claim preparation, claim submission, dispute management, and reconciliation.
2Why is Revenue Cycle Management important in healthcare?
It helps to ensure consistent cash flow and superior service. Revenue Cycle Management impacts both the healthcare provider’s short-term service capabilities and its long-term operating margins and sustainability.
3How can a healthcare organization improve its Revenue Cycle Management?
By automating the process with a leading technology partner, such as the Nividous platform. Once applied, organizations can dramatically improve core processes in order to ensure dependable revenue while demanding fewer staff hours.
4What is the most important part of Revenue Cycle Management?
An integrated approach that requires your clinical, financial, and operational data to work together. To run a successful business, it is crucial to automate tedious tasks and free up specialized employees to focus on the patient experience, leading to efficient organizational growth.

Meet Your Revenue Cycle Management Needs With the Nividous Platform