Revenue Cycle Workflows

The flow of healthcare payments have changed fundamentally over the past several years. The move toward electronic adoption of EDI files has been highly successful in the claims area using EDI 837 formats, but less successful at an industry level using EDI 835 files for remittance and payment processing. Although the adoption rate continues to climb for EDI 835 as well as ACH/EFT payments, a slower adoption curve causes downstream problems in receivables by creating posting delays, patient payment errors as well as missing information for analytics and reporting.

Providers can find it challenging to decipher where in the revenue cycle process a particular function should be completed. For example, as many as one of five healthcare entities (solution providers) could provide services such as EOB conversation for automated positing into the PMS/HIS system.

The Orbograph Healthcare Payments Automation Center (HPAC) is highly adaptable to any revenue cycle environment or healthcare payment process. The HPAC solution is cloud-based, making it available to virtually every entity in the revenue cycle flow. Accessible via industry standard FTP automated scripting, any HIPAA covered entity can access the system for EOB conversion or reconciliation processing.. Examples include:

Clearinghouses: As a natural aggregator of claim information, a clearinghouse typically has access to all claim data, EDI 835 files, PDF EOBs or scanned EOBs. A nature step in this process is to forward images to HPAC for processing.

Financial Institutions: Banks provide medical lockbox services to healthcare providers. Many times, banks do not have the capacity or systems in place to convert all paper to electronic files for posting. HPAC can be easily integrated into these lockbox platforms

Billing Companies: Billers perform a critical task for those providers looking to outsource functions of PMS, billing, coding and statement distribution. Processing EOBs via HPAC is a natural addition to the services billers offer.

Service Bureaus: Large and small transaction processing companies establish data centers for processing remittance and payment transactions either directly to providers or on behalf of financial institutions. HPAC integration to a service bureau naturally automates processes in EOB conversion where many service bureaus handle manual or ignore today.

Business Process Outsourcers: HPAC can make the outsource function more efficient for these organizations by driving down unit costs even further and making operations more scalable.

PMS/HIS/Denials Management Software Companies: The core function of the PMS, HIS or denials management is offered by many companies in the industry. HPAC provides a value-added plug-in to these applications by completing the critical function of paper processing on behalf of these software oriented companies.

Direct Healthcare Providers: Of course, large healthcare providers may find it beneficial to keep existing workflows in place and utilize the many benefits of HPAC. See SNCH video for a thorough review of capabilities for hospitals and physician groups.

Testimonial

“HPAC’s ability to integrate into the flow within the revenue cycle provides a unique opportunity to enable our business partners to expand their solution suite.”

- Roni Boker
Director of Product Management, Healthcare Solutions

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