Revenue Cycle Technology (RCT) is the use of systems, processes, people & technology to generate revenue for healthcare services provided. 

Before RCT the industry was referred to as 'Revenue Cycle Management (RCM) due to the dependency on a small group of people with expertise in the industry.

With the general availability of information technologies such as - 

  • Robotic Process Automation (RPA)
  • API based system integration (HL7, FHIR)
  • Artificial Intelligence (AI)
  • Knowledge Management Systems

the dependency on people has greatly reduced, making new, scalable solutions available for healthcare providers at highly affordable prices.

The organization responsible for coining the term 'Revenue Cycle Technology' and showcasing its capabilities is AuroraRCM. AuroraRCM was founded by industry veterans who realized the need for Technology in Healthcare Revenue Cycle. The company was named after the Latin mythical goddess of dawn - Aurora who symbolizes Dawn, Light and New possibilities. 

The need for a technology-enabled healthcare revenue cycle solution has been prevalent for decades. Traditional Revenue cycle companies charge healthcare providers a percentage of collections while RCT companies are able to provide superior services, consistent quality and automated solutions for a fraction of that cost. At the birth of any industry, middlemen are required to bridge the gap between two key players. This gap has been made short by the introduction of Revenue Cycle Technology giving healthcare providers a better share of their revenue. 

Revenue Cycle Technologies so far has taken the form of three categories targeting the needs of healthcare providers. 

  1. Business Intelligence 
  2. System interoperability
  3. Workflow automation

Business intelligence:

Business intelligence is a key requirement in any industry. However, in Healthcare, it plays a pivotal role in identifying opportunities and helping allocate resources. Example: A physician would not know the potential revenue opportunity of not participating in an insurance network. A common misunderstanding in insurance network participation is that the provider can choose to charge a higher amount that he/she believes is reasonable. But the amount of patient responsibility and re-circulation of a claim between the insurance and the patient can be far more costly. 

Meaningful business intelligence helps providers make the right decisions by showing the factual implications of a practice. 

System interoperability:

There are two types of software systems used in the healthcare space - 

  1. Patient Care Systems (where all the clinical care information is stored)
  2. Billing Systems (where all the financial work gets managed)

There is no other industry where 'legacy', 'on premise' systems are more prevalent than in the Healthcare industry. Due to the large investments that have gone into these systems, the decision to change can be painful. Due to the lack of integration between Patient Care Systems and Billing Systems, a lot of manual labor is used to transfer data from one system to another. With RCT, this step is no longer necessary. RCT is able to directly integrate two systems so that they work as one and duplicate labor is eliminated, saving valuable time and resources. 

Workflow automation:

The process of converting a medical service into a payable claim involves multiple steps from gathering the correct information, insurance verification, service authorization, medical documentation to coding. In case of a claim rejection or denial, the process re-starts. 

Revenue Cycle Technology is able to understand all possible outcomes and be programmed to take the right action based on any claim situation. This eliminates the need to be dependent on few highly experienced professionals and because the solution uses a computer, the possibilities of human error are removed from the equation, ensuring 100% compliance 100% of the time. 

The introduction of RCT to healthcare marks a remarkable milestone in the technological capabilities of mankind. Technology has always elevated human capabilities and enabled us as a species to move from one level of effectiveness to a higher level of effectiveness. Computer algorithms have enabled us to move from performing 'repetitive tasks' to 'prescribing solutions'. 


AuroraRCM LLC.

2021-05-09 00:39:53

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