Healthcare Revenue Cycle Management

Enhance your cash flow and patient billing process.

The financial health of any healthcare enterprise begins with the strength of its cash flow and the efficiency of the patient billing process. E3 Revenue Cycle Management Solutions are tailor-made to simplify the billing and collection process, preventing un-recoverable loss of revenue.

Our RCM Solutions comprise of state-of-the-art rules engine and application configuration tools, designed to define complex rules, conditions and near-impossible business process flows with ease. With improved scalability and flexibility, our revenue cycle management and patient-billing solutions help streamline billing processes, reduce gross days receivables outstanding, maximize and optimize collections, and improve the cash-flow.

“Revenue Cycle Inefficiencies Accounted for 15 Percent of Spent on Healthcare. Fixing the RCM Challenge Will Optimize the Process and Save Significant Funds That Can Be Used to Improve Care and Reduce Cost”

-Mckinsey & Company

Automation In RCM

In today’s Healthcare System, automated Revenue Cycle Management is a critical component to cater to the growing number of patients that rely on Health Insurance or Third-Party Payors to fulfill their financial obligations.

At E3, we focus on transforming Revenue Cycle Operations at Hospitals and Healthcare Establishments, tailored to meet the unique requirements of the GCC and the Levant. With strict protocol that covers every aspect of our services from conceptualizing, right through development and implementation, we ensure that our solutions adhere to local regulations, insurance practices and the highest quality standards.

Our deep local expertise and expertise are the special ingredients to our success in designing and implementing Healthcare Revenue Cycle Management Systems in the region.

E3’s goal is to help hospitals provide high quality of care and improve resource utilization, while ensuring accurate patient-accounting and real-time financial visibility.

Percentages of healthcare establishments that automate various aspects of Revenue Cycle Management:

Codind Assistance
Claim Scrubbing
Eligibility-Inquiry Checks
Tasking Staff & Denial Follow-Ups
Appointment Reminders
Reporting

An accurate and robust Revenue Cycle Management System is essential for the success of Private Healthcare Providers around the globe.

Patient Billing

Enhance your cash flow and patient billing process.

In a highly-competitive healthcare market, where healthcare costs are rapidly increasing, both healthcare providers and third-party payors should manifest seamless coordination for exceptional patient-care.

With the help of a tailored-made automated Revenue Cycle Management System, there is complete transparence and clarity, which allows better fluidity of transactions when required, giving way for timely healthcare and more positive outcomes. The ability to manage data into information is imperative for rapid decision-making in patient-care.

Our Patient-Billing module – available with our Healthcare Applications Suite – has several benefits, such as:

  • Advanced flexibility for improved charging, tracking and sharing of consolidated billing information across teams, departments and entire facilities.
  • Patient-charges can be entered directly within other Lawson Modules and/or via an interface with external components.
  • Full command of a business process environment, maintaining cost controls and revenue management.

The Patient-Billing Module is seamlessly integrated to all in-house applications and receives data from several sources, namely:

  • Master Patient Index,
  • Registration, Pharmacy,
  • CPOE, Laboratory
  • Radiology, and more…

The module also acts as a data-source for:

  • Approvals Management,
  • Claims Management,
  • Accounts Receivable, and
  • Provider Payables, among other departments.

Insurance Contracts

In modern healthcare environment, getting entangled in a complex payor environment is inevitable. With government, charities and insurance companies that form a major and varied source of payor groups, each entity tends to have unique regulations, policies and guidelines that govern patient-care payments.

Third-party payors enter into contractual-agreements with patients and healthcare providers to bridge the gap between costs and payments of healthcare services. These agreements usually include strict protocol and guidelines that form the basis on which insurance claims are validated.

With guidelines as diverse as care-seekers, healthcare providers are obliged to manage patient-eligibility while providing optimal care simultaneously. Automation aids in maintaining high quality of service by simplifying the billing, claims and receivables processes.

E3 Payor Management System

The E3 Payor Management System provides the ideal solution by completely automating the eligibility process – validating each patient against every contract accepted by the practitioner / establishment in real-time during the ordering process.

Our automated payor management system ensures patient insurance validity, eliminating the need to manually manage denials, collections and delays in receipts.

Scrubs & Claims Processing

The claims processing procedure within the system is, by all counts, an exceptionally simplified process. Prior to finalization, claim audit processes are performed to ensure completeness and comprehensiveness. Editing claims is permitted with Specialized Rehab Hospital user authorization and should be completed in the originating system.

There is no need to have a clear definition of claims “period”. Accruals basis of revenue recognition is defaulted.

Claims can be in traditional manual form or through paperless electronic environment. Claim submission can be multi-tied to include third party administrators.

Integration to e-Claims

Integration to eClaims module facilitates the receipt and submission of electronic claims transactions using CSV or XML formats. It maintains up to date version of the claim formats by payer, thereby enabling the generation of the correct e-claim transactions.

The module currently supports the following country specific National Health Insurance standards:

  • UAE: Shafafiya Transaction set (Abu Dhabi Health Authority)
  • UAE: eClaimLink Transaction set (Dubai Health Authority)
  • Qatar: MDS Transaction set (Supreme Council of Health)

This covers the submission of Claims and related transactions and the receipt (responses) from the third-party insurance organization or TPA.

integration 2

Rules Engine

The Rules Engine forms the core of the entire Business Suite. The engine provides ultimate flexibility to define just about any rules, conditions, processes, alerts and workflows that enable near-flawless, completely automated environment. Some of its most promising features include:

  • Line by line contract translation.
  • Diagnosis-based exclusion.
  • Handling of exclusions, deductibles, coverage etc.
  • Specific requirements like deductibles on gross, deductibles on net.
  • Patient-level Policy definition to handle eligibility and charity patients.
  • Multiple payor to single patient.
  • Ability to define rules based on specific and combined information:
    • Service group , category , item code
    • Medicine generic, medicine form, medicine category, medicine code
    • Patient sex, patient age, patient nationality etc.
    • Diagnosis code
    • Doctor specialty, doctor sub-specialty , doctor type
rules engine
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