Greenway Medical Technologies, Inc., which delivers innovative software and business services solutions for ambulatory care providers through its PrimeSUITE® platform, today announced that its PrimeRCM® service has been evolved to include a robust rules engine that integrates advanced billing intelligence with clinical care.
In addition to helping speed collections and optimize revenue by generating faster, cleaner claims, PrimeRCM lays the foundation to prepare providers for the shift from fee-for-service to outcome-based payment and delivery models coming to the U.S. healthcare industry.
Improved Claims, A/R and Collections with Reduced Effort
The PrimeRCM rules engine and team of experts deliver deep knowledge of industry compliance and claims-exception data to each practice, clinic or enterprise that adopts PrimeRCM, and the rules engine continuously generates new rules based on transactions specific to each organization. This ongoing fine-tuning helps minimize repetitious errors, with goals to have more than 90 percent of claims paid on first submission, shorter accounts receivable cycles, greater than 95 percent net collection rates and up to a 50-percent reduction in back-office work.
With these advancements, the rules engine now extends to the point of care, identifying not only what changes should be made to minimize denials, for example, but also how to follow payer guidelines as to what tests and procedures — and in what order — they have determined to contribute to optimal, cost-effective care. By going beyond optimizing revenue to also assist in optimizing outcomes, PrimeRCM will help physicians continue to succeed financially as industry payment models undergo transformation related to the consumerization of healthcare.
“The evolutions we’ve made with the PrimeRCM service are a key element in Greenway’s quest to contribute to a clinically driven, patient-engaged, coordinated healthcare system,” said Greenway® President and CEO Tee Green. “Increasingly, providers will be paid not on the basis of the transactions they’ve completed, but how well they are engaging the consumer and coordinating care to ensure successful outcomes. The delivery of rules to the point of clinical decision-making is essential to getting claims paid on time and efficiently while helping ensure that patients are being treated in the best way possible.”