Managing director of King, Edward with a focus in pharmacy and healthcare.

Revenue cycle management (RCM) describes the part of healthcare administration that focuses on tracking and optimizing revenue collection. While RCM encompasses a number of processes, it is commonly thought of in terms of software systems.

RCM software is big business. One industry observer 

 the RCM software market size to be over $52 billion, expected to grow to $114 billion by 2025.

Revenue cycle management is most commonly seen in the healthcare industry specifically because of the extreme and increasing complexity of healthcare billing and reimbursement.

Passive real estate investing is ideal for physicains

There are two primary benefits of an effective RCM system.

First, there are significant cost reductions associated with automating and digitizing a practice’s claims, billing, and reimbursement functions. The Council for Affordable Quality Healthcare (CAQH) reports that healthcare businesses 

 from strearmlining administrative processes like revenue cycle management in 2020. There are further benefits to exploit as well; for example, CAQH also estimates that another $16 billion in savings could be realized just by fully automating nine common transactions.

A second set of revenue cycle management benefits come from improving revenue collection both from insurance companies and from patients. This responds to 

the #1 concern identified by hospital administrators

in a comprehensive survey: reimbursement. The best RCM software will minimize claim denials, deliver invoices more quickly for faster turnaround, and provide exception-based reporting when manual intervention is required.

While there are no benchmarks for the benefits of RCM software for individual clinics, data from one 

 suggests that extremely significant revenue increases of 27% to 45% can be achieved.

While RCM software is most commonly thought of as relating to claim submission, insurance denials, and payment collection, administrators can and should expect that an RCM system provides end-to-end management of the patient/revenue process. For example, RCM software should:

Gather patient insurance and demographic information before they arrive at the point of care and confirm this information at the time of the patient’s appointment.

 Many claim denials can be prevented by ensuring complete and accurate collection of patient and insurance data from the beginning.


Verify the patient’s insurance information and coverage with respect to the recommended course of treatment.

 Many RCM systems are set up or can be customized to verify insurance coverage automatically, replacing time-consuming phone calls and faxes.


Collect patient co-pay based on insurance information and recommended treatment.

Properly code and submit claims to payers using CPT and ICD codes.

 High-quality RCM software should come pre-loaded with templates to allow for efficient claim submission to common payers such as insurance companies.


Manage the claims processes, including addressing insurance denials and executing follow-up billing to the patient as appropriate.

 Quickly appealing denials (when appropriate) 

Provide customizable reporting and analysis tools.

 These tools will become increasingly important, 

according to the University of Illinois in Chicago

, as the healthcare system moves from a purely fee-based model to one incorporating more value-based reimbursement. The data provided by an effectively implemented RCM system can allow providers to achieve higher reimbursement rates.


Choosing an outsourced RCM system can be a challenge. Once a system is deployed and staff are trained on its use, it can be difficult to decide to change course. This places pressure on administrators to make the right decision the first time.

Unfortunately, it is not always easy to evaluate something as complex as an RCM from demos alone. While imperfect and subject to manipulation, software review sites such as 

 can add to the due diligence process, combined with recommendations from similarly-sized comparable providers.



Ways to play the prior authorization game

As noted above, industry observers expect the RCM software market - a proxy for use of RCM systems - to continue to grow rapidly, fueled by the significant benefits that these systems bring to physicians, clinics, and hospitals.

It is likely that the benefits of RCM will increase in coming years. As many medical administrators can confirm, the claims reimbursement process tends to increase, rather than decrease, in complexity over time. As payers, including insurance companies, themselves digitize and automate their processes, providers and administrators relying on legacy systems risk being left behind.

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What physicians and practice managers need to know.

Revenue Cycle Management: Benefits and best practices

Even the best physicians face the possibility of a lawsuit on an almost daily basis. However, research shows that many lawsuits today are not about medical errors, but about poor communication and misunderstanding.

Ensuring effective communication should become a systematic and integrated approach into overall efforts to minimize errors, improve outcomes, control med-mal costs, maintain contracts, and manage the reputation of your practice.

Below is a practical guide, based on 28 years of experience working with physicians, to minimize liability claims stemming from communication oversights and misunderstandings.

Ways to avoid a malpractice suit

, CPCU, RPLU, is president and chairman of the board of The MGIS Companies, a leading national provider of physician insurance products. With nearly 30 of experience, Brunken is an expert on physician protection. 

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Here is a practical guide to minimize liability claims stemming from communication oversights and misunderstandings at your medical practice.

Part two of our look at stories from current headlines puts abstract conversations about asset protection, insurance, compliance, and risk management issues into the real-life context of current national headlines.

 we have previously advised you to manage proactively including social media, employment law and the COVID-19 vaccine. The headlines of the last few weeks are no less varied in the lessons they can provide.

Identity Theft Is Spiking – And Now They Probably Have Your Cell Number

We’ve discussed that both medical practices and their physician owners are popular and frequent targets for cybercriminals and some of the 

 protecting yourself requires. Things got a little harder this year as the identifying details of hundreds of millions of Facebook users was made available for free. As 

Over the weekend, news broke that a hacker had published online

a database containing the personal information of 533 million Facebook users

, including email and physical addresses, phone numbers, birthdates and more. While the data was stolen in a 2019 breach and Facebook long ago plugged that hole, it’s the first time this huge trove was made available for free.

What this means for consumers is that you will need to be extra vigilant about 

, using two factor authentication and carefully screening any 

 as likely phishing attempts, which are already increasing by using this information. Be extra leery of anything with a link or an attachment and look out for common scams including fake package and Amazon delivery updates.

Reconsider Business, Personal Security, and Your Need for Privacy

Physical security issues that can pose a risk to life and business takes many forms and we’ve examined the need for your practice to consider 

, a gun policy and heavy levels of several kinds of insurance in areas including 

. There has been a public shooting reported in different parts of the country 

 and his family by a patient. In this case, unlike the majority of other incidents involving medical professionals that are usually 

, the attack took place at the physician’s 

 and spilled over to other family members. This tragedy highlights the need for situational awareness and security precautions at all times as well as the need for physicians to take efforts to keep their residential addresses private by using trusts and other legal devices to legally keep their names out of public records. Having something like, “Dr. Sheila Smith and husband Bill Smith Just purchased this lovely contemporary home in located at 2345 East. Mountain Top Lane for $2.5MM” published in your local paper on the internet is a bad idea for many reasons. Think about your need for privacy and security well before closing on any real estate purchase.

Due Diligence in All Things Financial is Still Vital

You may have noticed a spike in reporting on investment fraud cases—it’s real and it affects a variety of industries and types of investment opportunities. Pushed by fears about the economy and uncertainty about taxes, investors are looking for opportunities and scammers are taking advantage of that in many ways.

All the basics of due diligence still apply from 

checking your investment advisor’s record

 and background to being conscious of the risks of private placements and investments, especially those that don’t use 

 or who promise outsize returns that other alternatives can’t match. One recent scam involved a Hollywood actor pushing a movie distribution deal that 

. It can also be a much smaller front-end scam that leads to a huge exposure, like 

 and discovering your agent wasn’t actually using your premiums to insure you, leaving you 

Doctors have always loved private aircraft, but we’ve seen a big increase in the number of clients interested in buying a private plane, spurred at least partially by COVID. Owning or flying an airplane carries 

 that can be fatal to you or others. Make sure you have professional help in how to own and insure the plane and 

, including life insurance, estate planning and asset protection in solidly place before you are wheels up.

, JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians and a frequent medical conference speaker and CME presenter. Learn more at

Asset protection, insurance, compliance, and risk management.

2021 Asset Protection Lessons in the News, Part Two

Dr. Reena Pande, Chief Medical Officer of 

, shares her thoughts on how physicians can remain updated with standards of care as they continue to evolve in this heightened era of telehealth.

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How physicians can remain updated with standards of care.

How physicians can stay abreast of new standards of care

Pat Hunt, MD, is the chief medical officer of QGenda.

Being a physician comes with certain baseline stressors. For most, the culprits are pretty familiar: patient care responsibilities, high debt loads that compel long working hours, system complexities, and mounting administrative chores. COVID-19 has added yet another layer to the burdens that already contribute to physician burnout.

As an emergency physician, walking into work every day for the last 12 months has felt like a roll of the dice. It’s been difficult to witness the effects of a disease that at times seems to affect people randomly. Despite what we know about COVID-19 risk factors, there are perplexing cases of severe disease with no apparent reasons. It’s a bit unsettling, especially given the realization that you may be putting yourself and others at risk.

Although we’re now, hopefully, turning the corner on COVID-19, many providers have endured significant mental health pressure trying to manage the pandemic’s challenges 24/7—both at work and home.

Ransomware attacks increase, OCR updates HIPAA

Whether the problem of physician burnout gets better or worse in the coming months will be driven largely by the provider community. The correlation between mental wellness, job satisfaction, and burnout has come to the forefront, but many physicians will tell you they don’t need wellness support. After all, we’re the ones trained to keep people well. That’s one reason practices sometimes see low engagement with programs designed to improve wellness.

In addition to wellness programs, another way for practices to reduce physician burnout is to lessen systemic stressors. In other words, to create a working environment where physicians are more likely to feel satisfied and less likely to burn out. While there’s not much practices can do about patient care responsibilities or debt loads, one powerful solution is to reduce administrative burdens and restore a degree of autonomy over physicians’ work/life balance.

Taking care of patients is what gets physicians up in the morning, not dealing with complex technologies and administrative tasks. Over time, however, both have increasingly shifted onto physicians’ shoulders. Electronic health records (EHRs) and payment paperwork are just two examples. In many ways, tasks like those feel like death by a thousand paper cuts.

There are huge advantages to technology in healthcare, of course. But just like anything, if a tool isn’t used properly, it can do more damage than it does good. Technology must improve the functionality of physicians and practices without increasing physician workload.

The use of scribes is a good illustration. Scribes leverage technology in a way that makes it easier and faster for physicians to do what they love and were trained to do, without forcing them to sit in front of a keyboard.

Similarly, scheduling technology offers opportunities to help physicians achieve a better work/life balance. As noted in a 

“…giving doctors flexibility in their schedule to allow for individual styles of practice and patient interaction was one of the few system solutions that reduced burnout. Flexibility in scheduling recognizes that both patients and doctors are individuals…”

Physician scheduling is a complex problem, with different wrinkles for different specialties. The right workload intensity varies from provider to provider; however, technology can be used to create fair and equitable schedules that honor physicians’ requests while maintaining parameters set by the practice and by each physician. The flexibility of such systems allows a more holistic approach to work/life balance than rigid, multi-week scheduling templates.

In fact, practices that use a single platform to optimize multiple resources—including clinical staff, non-clinical staff and room resources—can improve two important contributors to physician satisfaction: efficiency and balance. Providers able to efficiently move from room to room while at work can do more of what they enjoy—care for patients—with less frustration. Likewise, giving physicians the ability to easily view, accept, and trade shifts increases their efficiency while also allowing them to better balance time at work with time away.

Satisfy physicians, patients, and practices

It’s known that people who are happy and enjoy their jobs tend to do better at their jobs. Physicians are no different; we take better care of our patients when we’re in a better mood. Reducing burnout is the right thing to do to ensure physicians’ mental wellness and improve the quality of patient care.

Technology solutions can offer sizeable advantages for overcoming administrative burdens such as scheduling to reduce physician burnout. But technology must come with a caveat: that it makes processes better and doesn’t completely overburden physicians. Using technology to make it easier for physicians to feel a sense of autonomy over their work/life balance is one-way practices can make substantive strides toward easing provider tensions and reducing burnout.

, MD, is the chief medical officer of QGenda.

Achieve simplicity, efficiency, and balance in your practice. 

Three keys to ease provider tension

Will point solutions continue to emerge, or will there be a widespread consolidation of programs and services? Dr. Reena Pande, Chief Medical Officer of 

, shares her thoughts in this clip from our interview.

Will point solutions continue to emerge, or will there be a widespread consolidation of programs and services? 

What to expect from point solutions in 2021

There is nothing more frustrating to physicians than knowing a patient needs a certain diagnostic test or medication and having them not be able to get it because their health insurance company won’t cover it. All too often, many services require prior-authorization (PA).

It wouldn’t be so bad if the insurance companies made the guidelines they use to make these determinations readily apparent to those practicing medicine. However, these guidelines are created by the insurance company (with a main goal being cost containment rather than evidence-based medicine), unavailable to treating clinicians, and often they use decades-old recommendations. We are often left to predict the insurance company’s decision.

Many of us feel that it is like playing an epic game where we try to give our best care to our patients, while the insurance companies deny as many tests as possible to increase their profits. The loser of this game is not the one who was able to get the least amount of services covered or earned the least money. Rather, it is the patient: delayed diagnoses/treatment, denied tests, forced to use less effective medications based on formularies developed by insurance companies using their own guidelines, and footing increased costs.

How can this prior-authorization game be played for better odds of winning?

While these tips may help get some services covered, they often still do not work. The insurance companies hold a lot of power over these medical decisions. The most important thing is to keep fighting the ones we don’t medically agree with. The day we all quit the battle is the day we lose the game and big insurance companies win and determine medical care. We must remain diligent in our fight for optimal clinical outcomes in all and each of our patients.

Prior authorizations are a pain for physicians. Here are a few things you can do to improve your odds of winning.

, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at Baylor College of Medicine in Houston. Rachel can be reached through her website, 

 of mine highlighted the surge in ransomware attacks over the past year. In light of CNA’s, the seventh largest commercial insurance company, 

 that it “sustained a sophisticated cybersecurity attack [Phoenix Cryptolocker]” which “

 and temporarily shutter its website” highlighting some key items that all persons should have in place when formulating ransomware policy and procedures is the focus of this article.

2021 Remote Patient Monitoring Changes: 10 key takeaways for practices

 issued a warning about ransomware attacks, which are “a type of malicious software, or malware, that prevents you from accessing your computer files, systems, or networks and demands you pay a ransom for their return.” These attacks are becoming increasingly sophisticated, often occur at night and on the weekends, and may also involve state actors. This is relevant because, as the checklist below reveals, one of the primary steps is to contact law enforcement before paying a ransom.

The FBI recommends never paying the ransom, as there is no guarantee that the scammer will send you the decryption key. Beyond that, the money you pay may be used to fund organized crime activity or acts terrorism while encouraging the future criminal activity by these cyber thieves.

In light of the uptick in and increasing severity of ransomware attacks, the following items should be considered as part of any ransomware checklist:

How to ensure a viable future for community-based specialty practices

This list is not meant to be comprehensive; however, it is a good starting point for any organization. The costs to any healthcare provider, business associate, or subcontractor can be significant. In addition to government investigations and penalties, class action lawsuits are time consuming and financially significant. Overall, it is imperative to implement adequate safeguards to detect ransomware attacks and be ready to respond in the event that one happens.

, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at

in Houston. Rachel can be reached through her website,

In light of a major insurance company recently being hit with ransomware, the importance of protection, detection, and correction cannot be over emphasized.

Compliance suggestions for mitigating ransomware attacks, aftermath 

In the last 12 months, the world has been forced to confront the fact that the technology supporting our healthcare system fell behind. From initial tracking, to mass testing, and now vaccinations, the healthcare industry has faced harsh criticism for its inefficiencies and disorganization.

Now, as we look to 2021 and the future of healthcare, we have a responsibility to ensure our infrastructure is sophisticated enough to handle different strains, vaccines, secondary conditions and more. Here’s how we get there.

How to become a superstar practice manager

A system is only as strong as the people who can access it. COVID-19 is one of the most expansive healthcare initiatives in the world’s history and we need tools that properly connect all those involved, including the patient. A patient-centered CRM portal provides all relevant health and medical records so everyone can better understand their own health, the health of their community, and the ongoing risks. It also allows physicians to engage with patients real-time, and enterprises can monitor large groups with minimal delay.

Questions on efficacy, especially with multiple vaccines, will only continue. Is the patient due for their second shot? Will there be a 2022 booster? Will people need additional vaccinations for different strains? Creating and maintaining a CRM ensures that patients will understand their eligibility, risk factors, and next steps when these issues come up.

The patient-physician-enterprise connection doesn’t end once a shot has been administered and it’s not just to handle the next major event described above. Being vaccinated is just like any other medical procedure: patients should be monitored to record adverse reactions or side effects as part of this ongoing mass-scale clinical trial. Having the right patient CRM portal and cloud infrastructure will help all three parties work together for possible adjustments or future changes to the vaccine based on that person’s demographic, health status, current location, etc.

At the beginning, our digital software failed us during the vaccine rollout due to its inability to keep up with shifting allocations, patient rescheduling and new distribution regulations handed down by the government. Creating and shipping the vaccines to distribution centers is only part of the problem: the real work lies in managing the process to get shots in arms. As more companies develop vaccines and more Americans become eligible, we’ll need to rely on technology that’s robust enough to handle the volume but agile enough to adapt to changes on the fly.

Eliminating staff gossip at your practice

The only way scientists and physicians can learn from the variety of treatments being used to fight COVID-19 is to share data. The patient-physician-enterprise connection needs to share information in both directions to ensure a sound health and safety decision. A digital CRM cloud provides all parties to coordinate, share, and act on data (e.g. the patient’s vaccination history, underlying health conditions and COVID-19 test results post-vaccination) in real-time. Pharmaceutical companies can use aggregate health records to monitor for potential side effects and adjust their vaccine. Physicians can report data to local health agencies more efficiently, freeing them up to focus more on their patient’s health. Implementing a robust CRM tool presents unlimited possibilities and brings us one step closer to bringing our current fragmented health ecosystem together.

This year is poised to bring about a health tech revolution centered around a virtual patient experience. The way we get there is through a robust, patient-centered, cloud-based CRM that links the patient, physician and the enterprise. These solutions will ultimately provide a better level of care to the patient now and in the future.

Healthcare needs a sophisticated infrastructure in place now and after the pandemic.

Cloud-based CRMs and vaccines

How providers should take issues into consideration when exploring point solutions for their patients.