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A Revenue Cycle Guide for Private Equity Firms in Healthcare

A Revenue Cycle Guide for Private Equity Firms in Healthcare

Private equity firms have taken on a significant role in the healthcare industry over the last decade. In 2018, the valuation of private equity deals in the US healthcare sector surpassed $100 billion, and it has only increased since then. Investors continue to see significant potential in the healthcare industry as our national healthcare spending grows year after year.

Private equity firms rely on leveraged buyouts to acquire assets and typically follow a business model of investing, scaling, and selling a company within three to five years. During this time, they often implement sweeping structural changes to extract as much revenue as possible. This process leaves its mark on revenue cycle management.

Private Equity in Healthcare: High Growth Challenges

Private equity investment brings its own set of growth challenges. In addition to typical healthcare billing challenges like poor billing and coding data coming from the EMR and ever-changing payer requirements, private-equity-backed healthcare groups are dealing with significant changes due to the growth imperative. Billing and coding staff may end up working out of multiple EMRs and PM systems at once. Institutional knowledge could suffer as teams integrate new staff or lose existing staff due to acquisitions or mergers. These challenges can lead to a lack of consistent standards and a multitude of billing and coding errors.

Automating Private Equity Revenue Cycle Management

RCxRules can help combat these challenges with our custom rule and automation capabilities. Our technology can integrate with multiple EMR and RCM systems and eliminate many of the manual tasks that come from working in multiple systems. RCxRules reviews charges at the front end of the process for coding completeness and accuracy immediately after entry into the EMR, before a claim is created. By acting as the connector of disparate systems, the technology can normalize data and automatically fix billing and coding errors.

Rules Repository

Custom rules and automation can also help optimize staffing. The system identifies only those charges that require manual review, so a team can focus their efforts where they’re needed most. Additionally, RCxRules provides one location to host an organization’s billing and coding knowledge. This centralized knowledge base allows teams to keep up with ever-evolving payer requirements and make sure everyone handles billing and coding issues consistently.

At RCxRules, we have a lot of experience working with high-growth organizations. We understand the importance of standardizing RCM processes and consolidating institutional expertise. Prior to working with RCxRules, one of our customers needed nine full time employees to process charges from their EMR to their PM system. Our Revenue Cycle Engine helped ensure clean claims without the need for 100% staff review, resulting in faster payer reimbursement. The group was able to reduce their number of full-time employees to review charges from nine to four, freeing up five employees to work in other important areas.

To learn more about how revenue cycle automation can help reduce the bottom line for private equity-backed healthcare organizations and other high-growth medical groups, set up a 1:1 meeting today.

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