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Revenue Cycle Services

Subject Expert
Boyd Stewart
VP of Payer/Provider Collaboration
KLAS VP of Payer/Provider Collaboration - Boyd Stewart

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Associated Market Segments

Complex Claims Services

Services focused on assisting provider organizations with complex claims—specifically, claims for workers' compensation, VA,...

Debt Collection Services

Services provided to healthcare organizations to collect the final balance on unpaid patient accounts.

Denials Management Services

Services that help healthcare organizations ensure they get reimbursed correctly for services provided, specifically in...

Eligibility Enrollment Services

Healthcare organizations' cash flow is supported via patient advocacy services that obtain eligibility and enrollment...

End-to-End Revenue Cycle Outsourcing

End-to-end engagements in which hospital-based organizations outsource all or key components of their patient access, HIM,...

Extended Business Office: Large (>200 Beds)

Ongoing collection services performed by a third-party firm for the business office of a hospital with 200+ beds. Includes...

Extended Business Office: Small (<200 Beds)

Ongoing collection services performed by a third-party firm for the business office of a hospital with less than 200 beds....

Government Reimbursement Services

Services that help healthcare organizations complete Medicare/Medicaid cost reports. Includes adjustments like DSH, IME, wage...

Outsourced Coding

Engagements where a third-party firm is used to help with provider organizations’ inpatient coding, generally on an ongoing basis....

Patient Financing Services

Vendor services offered by provider organizations (through vendor/provider agreement) that give patients additional...

Physician Advisory Services

Services that help organizations with their physician and utilization review.

Release of Information

Service involving release or disclosure of patient record information and all associated tasks such as obtaining patient...

Transcription Services

Services where a provider organization outsources a portion or all of its medical transcription and/or editing to a medical...

Underpayment Recovery Services

Contingency services firms that perform audits and reviews to proactively discover missed revenue opportunity. This includes...

Value-Based Care Enablement Services

Services that provide healthcare providers, payers, and accountable care organizations (ACOs) with technology, analytics, and...

Virtual Scribing Services

Services that provide remote/virtual scribes who take critical notes during patient visits and document each encounter.
Related Reports View All Reports
Performance
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Virtual Scribing Services 2024
27 December 24    |   Dallin Seely and Don Seamons
As provider organizations continue to look for solutions to improve the clinician experience and reduce administrative burden, documentation technology and services remain front of mind. Though much energy is focused on emerging technologies (e.g., AI or ambient speech), many organizations continue to rely on virtual scribing services to ease the process of documentation for providers, ultimately hoping to reduce burnout and retain valuable staff. This report—an update on KLAS’ 2022 research —provides insights into what value customers receive from virtual scribing services and what impact scribe turnover has on overall satisfaction. KLAS recognizes that other firms not measured in this report (e.g., DeliverHealth, ScribeAmerica) also provide virtual scribing services; some of these firms are moving away from human scribes due to the rise of AI-powered documentation technology. While there is a lot of excitement around AI and ambient speech, provider organizations continue to find value in virtual scribes for certain specialties or due to provider preferences. As a result, virtual scribes will likely continue to have a place in documentation offerings for at least the near future. (See last section in report for more information.)
White Paper
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Value-Based Care Enablement Services 2024
05 December 24    |   Andy Paulsen and Benjamin Cassity
The transition from a fee-for-service payment model to a value-based care (VBC) and risk-based model can be daunting for provider organizations, especially those that lack the necessary data and resources to realize an ROI on VBC initiatives. Organizations can streamline the transition by joining ACOs managed by VBC enablement firms. With these firms’ services and technology offerings, organizations can aggregate more data, develop care management models, and effectively manage risk-based contracts. This services firm guide is intended to provide a simple starting point for organizations investigating VBC enablement services. All such firms known to KLAS as of October 2024 are included in this guide. In the future, KLAS plans to publish a follow-up report exploring organizations’ adoption of and satisfaction with these firms.
Performance
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Physician Advisory Services 2024
19 November 24    |   Braden Taylor and Mollie Hunt
Provider organizations are required to juggle both regulatory and payer contractual challenges while maintaining high-quality patient care. Physician advisory services firms seek to support organizations in these efforts by ensuring prompt, accurate care decisions; adherence to billing standards; and reduction of clinical denials. This report examines the key elements that drive client satisfaction across the physician advisory services market, including execution when making determinations, the strength of client-firm relationships, and the service lines most viewed as market differentiators.
Performance
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Underpayment Recovery Services 2024
24 October 24    |   Mollie Hunt and Shawn Howell
Amid continuing financial pressures to increase revenue with fewer resources, many provider organizations look to firms that can not only recover underpayments but also help improve internal processes to prevent future revenue leakage. Since the 2022 report on underpayment recovery services, KLAS has broken out a denials management services market segment ( reported on earlier this year ); now, underpayment recovery services include charge capture, transfer DRG, DRG validation, and zero-balance review. Additionally, there have been several acquisitions that have affected the market (i.e., the R1 RCM acquisition of Cloudmed, the FinThrive acquisition of TransUnion Healthcare). This report explores what service lines organizations use firms for, how well firms provide actionable insights, how firms help organizations prevent future revenue leakage, and what factors drive firm selection across the market.
Performance
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Complex Claims Services 2024
27 August 24    |   Braden Taylor and Mollie Hunt
Healthcare organizations continue to depend on specialized firms to manage their complex claims—specifically, claims for motor vehicle accidents (MVA), out-of-state Medicaid, TRICARE, VA, and workers’ compensation. Notably, several complex claims services firms have recently completed a merger or acquisition, resulting in expanded offerings, deepened expertise, and larger market share. This report looks at client satisfaction in the wake of these mergers and acquisitions, examining how well firms partner with clients and deliver value across different claim types.
Performance
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Denials Management Services 2024
29 March 24    |   Braden Taylor and Mollie Hunt
Healthcare organizations continue to face challenges with getting reimbursements, due in part to large volumes of complex medical claim denials issued by payer organizations. To access expertise in managing the appeals process, many healthcare organizations are engaging denials management services firms, who utilize multidisciplinary teams (e.g., legal, clinical, coding) to review accounts and submit appeals. This report—KLAS’ first on denials management services—examines which firms consistently deliver strong execution, expected overturn rates, expertise, and partnership in denials prevention.
Performance
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Extended Business Office Services 2024
12 February 24    |   Mollie Hunt and Shawn Howell
Provider organizations are facing intensifying revenue cycle complexity, payer relations, cost pressures, and staffing shortages, along with the resulting loss of resources and expertise. To find relief from some of these pressures, many are seeking outsourced extended business office services (EBOS) offered by firms that can execute revenue cycle management (RCM) work more economically and with greater efficiency than organizations can in-house. To share insights into a shifting market, this report provides (1) an update on client satisfaction and adoption and (2) a look into provider plans for outsourced revenue cycle services and satisfaction with offshore resources.
Performance
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Debt Collection Services 2023
22 December 23    |   Mollie Hunt and Sam Eaquinto
Amid current economic challenges, healthcare organizations are contracting with debt collection services firms (often multiple at a time) to ensure financial stability, leverage specialized expertise, and comply with complex regulations. These firms possess the resources and knowledge to efficiently and ethically recover unpaid medical bills—supporting positive patient relationships and saving time for health systems so they can focus on providing quality care. In a market where most firms perform highly, this report—KLAS’ first on debt collection services—examines which firms provide strong technology, foster partnerships, and drive outcomes across organization sizes. Note: While there are many regional debt collection firms, this report focuses on firms with a national presence.
Performance
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Release of Information 2023
06 October 23    |   Jaren Day and Justin Porter
With information blocking regulations pushing for patients to have enhanced, easier access to their data, healthcare organizations increasingly need technology that improves release of information (ROI) efficiency. Services firms in the ROI space are generally high performing, with most offering similar strengths and experiencing similar challenges. To provide differentiation, this report looks at (1) different ROI service models and which firms perform best for each model, (2) how firms perform operationally, and (3) what technology efficiencies measured firms provide.
Performance
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End-to-End Revenue Cycle Outsourcing 2023
21 September 23    |   Mollie Hunt and Shawn Howell
Aftershocks of the COVID-19 pandemic have made it difficult for hospitals and health systems to control costs and find and retain the right staff. In an effort to achieve stability, healthcare executives are looking to external partners for help, including end-to-end revenue cycle outsourcing (RCO) firms. Though organizations have similar motivations for partnering with an RCO firm, not all firms take the same approach to meeting clients’ needs. This report examines the performance of end-to-end RCO firms, reasons provider organizations outsource their revenue cycle, why they chose the firms they did, and the models and approaches of these firms.
First Look
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CareAllies Value-Based Care Managed Services 2023
06 September 23    |   Bradley Hunter and Jacob Mortensen
Competitive and financial factors continue to drive organizations toward value-based care. A widely varied array of services firms and other vendors offer services and solutions designed to help. This report details CareAllies’ value-based care managed services offering and examines client experiences.
Performance
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Outsourced Coding 2023
20 June 23    |   Gordon Bishop and Shawn Howell
Amid the healthcare industry’s ongoing staffing shortages, many healthcare organizations are turning to external firms for outsourced coding services. These firms can provide valuable coding expertise and help control coding-related costs. This report aims to help organizations choose the right firm for their needs—detailing firms’ ability to deliver value, exceed client expectations, maintain consistent staff and high coding quality, and partner with their clients.
Point of Light
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Points of Light 2023 Case Study 20
15 April 23    |   Aurene Wilford and Boyd Stewart
Inpatient treatment for high-risk cardiovascular patients comes with a significant cost for patients, providers, and payers. Costs are lower and outcomes are better when the care for these patients is effectively managed outside the hospital. To achieve this, the collaborators in this case study combined payer and provider data to better predict costs and patient outcomes and then established a bundled payment contract that reduces the costs of caring for patients with high-risk cardiovascular diseases while ensuring they receive the care appropriate for their condition. Outcomes include reduced hospitalization and lower costs.
Point of Light
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Points of Light 2023 Case Study 21
15 April 23    |   Aurene Wilford and Boyd Stewart
The collaborators in this case study noted that some patient populations were completing preventive annual health assessments at lower levels than other populations. To address this disparity and help clinics close care gaps at the point of care, the collaborators implemented a program aimed at incentivizing frontline staff and physicians on a monthly basis for time spent addressing open care gaps. As a result of the program, the participants have seen improved gap closure, improved performance in quality measures, improved coding accuracy, and higher staff morale and engagement.
Point of Light
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Points of Light 2023 Case Study 15
14 April 23    |   Aurene Wilford and Boyd Stewart
Patient data often exists in silos, leaving healthcare organizations with poor visibility into care given at other facilities and preventing payer organizations from being able to access a full view of their members’ clinical history. To give both parties a more robust clinical picture of each patient’s care journey, the collaborators in this case study invested in technology to map non-standardized CCD data into one unified medical record that gives both the payer and the provider the ability to track patients across settings and over time. The project has streamlined data-exchange processes and improved performance in quality measures.
Point of Light
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Points of Light 2023 Case Study 17
14 April 23    |   Aurene Wilford and Boyd Stewart
Vulnerable and underserved populations face a variety of barriers that can make it difficult for them to adhere to their prescribed medication regimens, and the impacts of non-adherence—in terms of health outcomes and costs—can be severe. Low medication adherence was a particular problem for the healthcare organization in this case study, whose patient population covers one of the most vulnerable and underserved zip codes in the country. To encourage better adherence among high-risk individuals, this organization collaborated with a payer organization and value-based care partner to identify patients in need of additional support and help resolve their barriers to adherence. Results include better health outcomes and higher CMS Star ratings.
Point of Light
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Points of Light 2023 Case Study 3
13 April 23    |   Aurene Wilford and Boyd Stewart
To meet CMS requirements for the submission of risk adjustment data and ensure they are being fully reimbursed by CMS, payer organizations need increasingly specific coding information, and these requests for information can put undo administrative burdens on provider organizations. Seeking to increase the payer organization’s access to needed information without increasing the provider organization’s workload, the collaborators in this case study established an API that enables an automated, standardized retrieval process for records that the payer organization needs in order to complete managed care audits.
Performance
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Patient Financing Services 2023
11 April 23    |   Gordon Bishop, Mac Boyter and Tyler Sycamore
Patients face many difficulties when paying for healthcare services due to the cost of care as well as increasingly high deductibles and co-pays. The majority of hospitals offer payment plans that last an average of six months, and the limited time frames lead to higher rates of bad debt. Patient financing services firms provide flexible, long-term payment plans (i.e., longer than six months) that can generate increased revenue for provider organizations and improve the patient experience. This report is KLAS’ first to focus on patient financing services, the associated successes and challenges, and clients’ perspectives of their firms.
Performance
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Eligibility & Enrollment Services 2023
04 April 23    |   Mollie Hunt and Shawn Howell
Amid rising healthcare costs and a challenging labor market, healthcare organizations face more pressure than ever to collect every dollar possible—leading them to utilize outsourced eligibility and enrollment services to help uninsured patients receive coverage. Healthcare organizations engage these services primarily to gain outside expertise regarding government regulations and programs and changes to eligibility requirements. This report—KLAS’ first to measure client satisfaction with firms that provide eligibility and enrollment services—explores how well these firms drive value, foster partnership, inspire loyalty, and maintain quality for their clients in a challenging landscape.
Performance
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Clinical Documentation Strategies 2023
14 March 23    |   Mac Boyter and Tyler Sycamore
For years, documentation has been a pain point that has led to clinician frustration and burnout, but numerous strategies have emerged to ease that burden and enhance patient care. COVID-19 has exacerbated burnout, leading organizations to renew their focus on improving documentation. This report examines physician-facing documentation technology and services (i.e., ambient speech recognition, front-end speech recognition, CAPD, CDI, transcription services, and virtual scribes), how vendors compare in overall scores, and the key performance metrics of value and outcomes.
Perception
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Transitions of Care 2022
29 December 22    |   Bradley Hunter and Paul Warburton
Inefficient care transitions lead to wasted time and energy, increased risk of human error, and potentially poor experiences for both patients and providers. Despite the industry’s attempts to ensure the right information is sent to the right people at the right time, healthcare organizations must often revert to manual processes for data entry, verification, and communication. Some organizations use or want to use technology to streamline their transitions of care (TOC). This report—KLAS’ first to look at TOC—draws from the perspectives of 95 healthcare leaders across multiple care settings to understand their adoption of care transition technology, the challenges they encounter in their care settings, and the vendors they are considering.
Perception
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Optum/Change Healthcare Merger
16 August 22    |   Boyd Stewart and Sam Eaquinto
In January 2021, Optum announced their intentions to acquire Change Healthcare. The merger remains unfinalized, however, as the US Department of Justice blocked the deal in February 2022 due to anticompetition concerns—such a merger would give UnitedHealth Group, Optum’s parent company and the nation’s largest insurer, access to rivals’ sensitive data. The legal proceeding is ongoing and scheduled to go to trial August 1, 2022. This report shares Optum and Change Healthcare customers’ reactions to the merger and their perceptions of its impact. Between March 2021 and April 2022, KLAS interviewed 48 individuals from 46 unique organizations; of these respondents, 9% are Optum customers, 56% are Change Healthcare customers, and 35% are customers of both vendors.


KLAS VP of Payer/Provider Collaboration - Boyd Stewart
Subject Expert
Boyd Stewart
VP of Payer/Provider Collaboration
KLAS VP of Payer/Provider Collaboration - Boyd Stewart




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