Leveraging clinically driven revenue cycle workflows for improved outcomes

Oracle Health | April 27, 2023

In today’s climate, healthcare organizations face a daunting challenge: to deliver optimal outcomes in less time, with fewer resources, and a depleted, burnt-out workforce. At the same time, organizations are also expected to meet or exceed cash and revenue goals while remaining compliant with ever-changing industry regulations and from consumers.

Now more than ever—with increasing financial pressures—organizations must improve their operational and financial outcomes while enhancing consumer and patient engagement. However, there’s often a process disconnect. Clinical settings, where care is provided, and front- and back-office operations, which manage registrations, scheduling, claims and payments, operate in silos. To best address these inefficiencies, or breaks in workflow, organizations require clinically driven, holistic systems that support both clinicians and back- and front-office staff.

By bridging the gap between the clinical and operational settings to streamline revenue cycle workflows, organizations gain enhanced, real-time insights for better patient, clinician, and staff experiences. So, how do we achieve a clinically driven revenue cycle that improves experiences and outcomes? The answer lies in automation and extensibility.

Prioritizing automation and extensibility

With automation and extensibility, we can help break down silos within healthcare systems to connect disparate data, gain more complete information, improve efficiencies, and enable workflow automation of repetitive tasks.

It’s critical that organizations incorporate automation within their revenue cycle workflows to help reduce business complexities. Healthcare—and more specifically, the traditional revenue cycle workflow—is complicated enough; by applying automation and intelligence to time-consuming, repetitive tasks throughout the billing cycle, organizations can free up valuable resources, such as staff members and their time, to focus on higher-priority initiatives.

For example, automation is becoming increasingly prevalent during patient preregistration for hospital and provider visits, significantly improving the registration process for patients and staff. It’s estimated that between 40 and 50% of the data required in a claim to receive reimbursement is captured during the registration process1, which highlights the importance of efficient and accurate front-end workflows, such as registration and scheduling. Without automated processes, backend patient accounting becomes substantially more difficult, and in some cases cannot be completed.

Extensibility is also an important aspect of a clinically driven revenue cycle, as a single health system typically works with hundreds of IT vendors. To truly achieve a clinically driven revenue cycle workflow, organizations can no longer be limited by the source of data. What matters most is how data is being used—not where it comes from. By leveraging APIs and an open architecture that brings together technology for a more unified user experience, organizations can streamline their workflows, enhance data between systems, and improve user satisfaction.

For example, if a revenue cycle has an open architecture, a third-party solution specializing in scheduling can be involved in the development process for that specific function. Open architecture creates more opportunity for healthcare systems and developers to mix and match their third-party technologies, benefiting both patients and clinicians from these flexible platforms.

How can Oracle help?

Watch the video: BayCare RevElate Executive Insights (11:29)

By establishing an extensible framework and automation to drive efficiencies, RevElate elevates the patient accounting approach. Through its open architecture, RevElate connects and supports workflows across Oracle Health, as well as third-party organizations and technologies—making it easy to manage cross-venue workflows through a single, efficient end user experience. For example, whereas users must normally leverage more than one system for contract management processes, RevElate brings that data into one place in the end user experience—eliminating the need to toggle between systems. RevElate also operates seamlessly with Oracle Cerner Millennium to provide a unified user experience across platforms.

“RevElate is helping advance patient accounting to streamline the cumbersome processes for providers and achieve less confusing, more straightforward billing for patients,” says Brenna Quinn, chief product officer at Oracle Health.

Workflow efficiencies generated by RevElate also help improve the patient experience; payer workflows are automatically triggered as clinical events occur across the continuum of care to help streamline bill payments. A key benefit of RevElate is its ability to leverage clinically integrated business rules into the workflow. Through this capability, clinical data needed for a claims submission, such as birth weight, is added to the claim automatically—eliminating the need for users to revisit the clinical record, find the necessary information, and manually add it to the claim.

“The more efficient we can make healthcare, the better we can focus our resources on serving our patients every day,” says Lynda Gorken, vice president, patient financial services at BayCare Health System. “We believe the next generation of Oracle patient accounting, RevElate, is an important step in that goal.”

Realizing an improved billing experience for all

Increased data access to better inform revenue cycles can benefit patients, clinicians, front- and back-office staff, and administrators. Patients gain greater transparency into financial commitments, clinicians can access accurate financial information within workflows and tools used to facilitate the care process—including the financial element of care delivery, and support and administrative staff can conduct their jobs more effectively. Ultimately, organizations that prioritize automation and extensibility will be best equipped to achieve clinically driven revenue cycle workflows that help realize a better billing experience for all stakeholders in healthcare.

Learn more about RevElate Patient Accounting .

1 Data obtained from RevElate in 2023 by comparing claims data fields used in CMS-1500 forms and Healthcare Enterprise (IHE) claims to information gathered during patient registration.

Oracle Health

Oracle Health is building an open healthcare platform with intelligent tools for data-driven, people-centric healthcare experiences to connect consumers, healthcare providers, payers, public health, and life sciences.