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Oracle Health

Clinical and Financial Operations

Revenue cycle management

Clinically driven and patient-focused—that’s the foundation of Oracle Health’s revenue cycle management (RCM) solutions. A clinically driven revenue cycle takes information captured by clinicians during care and uses it to drive financial outcomes.

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Revenue cycle management solutions       Oracle Health Patient Administration Patient access Midcycle Patient accounting Transaction services Oracle Insurance Revenue Management and Billing Oracle Health Insurance Management System             Oracle Health Patient Administration Oracle Health Patient Administration helps ambulatory practice staff coordinate care with guided workflows and task automation for scheduling and registration. Capabilities include workflows that help manage patients, appointments, encounters, resource schedules, and financial approvals.      Empower patients Oracle Health Patient Administration provides self-service capabilities that enable patients to complete scheduling and registration tasks themselves, including registering, confirming, and checking in for upcoming appointments. These new self-service workflows give patients convenience while helping reduce phone calls and front-office workloads, freeing your staff to perform other important duties. Through an integration with Oracle Health EHR, the information captured by patients is available to all users in near real time without requiring staff intervention or complex configurations.  Advanced security and innovation Oracle Health Patient Administration is a cloud native, SaaS-based solution powered by Oracle Cloud Infrastructure, which provides the same military-grade security used to protect the most sensitive data at some of the largest and most sophisticated businesses, national defense agencies, and governments around the world. The solution directly integrates with Oracle Health EHR, enabling the easy adoption of new enhancements—by persona and care venue. Oracle Health Patient Administration will leverage existing data models and database tables, helping limit implementation effort for existing customers.       Optimize staff workflows Guided processes offer personalized recommendations to optimize staff workflows and productivity, helping users know what steps to complete and when within their workflows. In addition to modernizing the user experience with guided workflows, Oracle Health Patient Administration offers additional task automation to help staff complete tasks faster and with less effort. For example, Oracle Health Patient Administration uses AI and machine learning technology to reduce manual processes, such as capturing information from driver’s licenses and insurance cards. With a fully responsive user experience—supported by desktop, mobile, and tablet devices—you can also give staff advanced flexibility in how they engage with patients to increase end user accessibility.  Explore Oracle Health Patient Administration             Patient access Gathering complete and accurate information from patients is a necessary step in managing your organization’s cash flow. Oracle Health can help your organization facilitate patient engagement and access by prioritizing the patient experience.      Scheduling Oracle Health Scheduling Management workflows help ensure patients are scheduled for the appropriate appointment to receive the right care at the right time by efficiently taking into consideration patient preferences, insurance specifications, and venues. Registration Oracle Health Registration Management solution provides users with a broad range of tools and workflows while simplifying the registration user experience based on venue, role, and operational procedures.  Learn more about patient access        Financial clearance Our financial clearance workflows, within Registration Management, help minimize the amount of information patients are asked to verify during preregistration or on arrival by evaluating whether the data is accurate and up to date, helping to improve the overall preregistration and intake experience.           Middle revenue cycle Start creating a compassionate care experience at the first patient touchpoint.      Oracle Health Acute Case Management Improve utilization management and care transition planning. Our Acute Case Management software can transform how your teams collaborate with each other and your patients as they perform clinical reviews and care transition planning activities in a connected, clinically driven revenue cycle system.   Learn more about our middle revenue cycle solutions         Oracle Health HIM Increase coding workflow efficiencies, automate chart completion, and simplify the release of information process. Our HIM solutions help you limit workflow fragmentation in your coding environment with a single platform that connects your clinical information to a third-party encoder to streamline billing processes.           Optimize financial outcomes through automation and extensibility Our comprehensive back-office solutions facilitate billing, charge capture, claims and AR management, as well as contract management across care venues. Streamlined back-office workflows enable your teams to prioritize essential tasks and limit manual administrative work.      Oracle Health Patient Accounting Simplify your revenue cycle operations for both your staff and patients. Oracle Health Patient Accounting supports accurate and timely reimbursement, optimizing your financial outcomes by leveraging clinically integrated, cloud-enabled billing workflows that offer automation and flexibility. Oracle Health Specialty Practice Management Equip your practice with intelligent tools to help address challenges in work experiences, revenue growth, collection speed, and productivity. Our comprehensive suite of practice management capabilities streamlines front- and back-office workflows, enabling your staff to focus on patient engagement and drive financial outcomes.   Explore patient accounting         Contract management Efficiently manage payer contracts across billing and contract management. Through contract management, you can view net receivables upon charge posting, offering detailed patient responsibility breakdowns, and supporting accurate reimbursement calculations with real-time repricing.            Healthcare data exchange We strive to lead the healthcare community by helping streamline and prioritize standards, integration, and information exchange software services that aim to connect and elevate employee, consumer, customer, and partner experiences. Leverage our trusted clearinghouse services to help facilitate accuracy and gain access to information that helps lead to a patient-friendly revenue cycle experience. Our healthcare network connects providers, payers, and other healthcare entities to facilitate interoperability throughout the revenue cycle. Healthcare data exchange aims to address the administrative complexities of healthcare by providing payer information in a way that complies with regulatory requirements.      Healthcare data exchange services   Claims management services Electronic remittance service ePayment Integrated eligibility service Integrated notification, authorization, and referrals Lock box service Patient-friendly statements Payment assessment services Web-based and batch eligibility checking   Explore more for customers and associates                      Explore Oracle Insurance Revenue Management and Billing for healthcare payers  Control revenue leakage and take advantage of an adaptive revenue management solution that helps you capitalize on new opportunities, respond to regulation changes, and improve operational efficiencies.      Streamline and automate billing, payments, and collections processes   Oracle Insurance Revenue Management and Billing  Manage multiple lines of business on a single billing platform Support exchange, individual billing, group billing, ASO billing (including stop-loss insurance), government plans, and more Minimize cost and risk via a HIPAA-compliant cloud solution Improve customer satisfaction with timely and accurate billing and transparency Scale to support high-volume billing    Learn more about Oracle Insurance Revenue Management and Billing for healthcare payers        Optimize member service and profitability  Automate billing to reduce processing costs Provide efficient service to employers, providers, and members Improve member and provider satisfaction Improve revenue management and cash flow Reduce risk and improve cost savings Improve operational ease with a workflow-based ability to set up customer policy structures            Oracle Health Insurance Management System Our system helps insurers simplify healthcare IT, improve operational efficiency, reduce costs, and adapt quickly to ongoing market and regulatory demands.      Drive operational efficiency with our healthcare claims processing solution  Gain the flexibility to manage business rules for different lines of business, provide a enhanced member experience, create products quickly, grow enrollments, and increase market share with a secure, affordable cloud platform that scales to meet the needs of healthcare organizations of all sizes.  Faster time to market Respond faster to market and regulatory changes by limiting the need for source code changes. Improve operational efficiencies and bring new products to market faster through collaborative product development.   Learn more about Oracle Health Insurance Management System        A transparent member experience Improve the enrollment experience with faster premium calculations, enhanced policy administration, advanced benefits adjudication, and accurate billing that can be deployed on-premises and in the cloud. Operational efficiency Lower health insurance claims management costs significantly by automating processes, and increase auto-claims adjudication rates using a business rules–driven workflow.

IDC MarketScape named Oracle a Leader in RCM

IDC positioned Oracle as a Leader in its 2022–2023 IDC MarketScape for U.S. RCM Product Solutions.

Read the IDC MarketScape report excerpt

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* Parts of Oracle Health Patient Accounting are under development. Oracle Health makes no assurances that the capabilities described herein will be provided in the product. The legacy Patient Accounting product is still being sold for certain markets, such as Oracle Health CommunityWorks. Oracle Health will work with organizations individually to establish an implementation timeline. Contact your Oracle Health sales associate to understand the path that is best for your organization. Learn more about Oracle Health Patient Accounting.

Revenue cycle FAQs

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How does patient access leverage third parties?

Our technology can use HL7 as well as APIs. These connections help streamline the user experience, and in some cases, provide advanced capabilities by combining Oracle Health data with partner data in ways that can drive decision-making and improve workflows.

What third parties does patient access connect to?

Review our current list of preferred supplier partners. However, if you have different third-party tools, patient access has the ability to connect through HL7 interfaces and APIs. The open developer experience (code) site has resources that can assist your support teams in leveraging the APIs Oracle Health has made available.

What is Oracle Health doing to enable interoperability and innovation?

The open developer experience program encourages innovators to build apps that advance the healthcare industry through improved interoperability capabilities. Using Ignite APIs allows us to scale and better support our API-enabled innovation and healthcare market. Third-party and client developers will find this approach gives the applications they develop extensibility.

How does patient access help manage duplicate patient records?

Patient access uses a single patient record to keep care, demographic, and historical documentation linked for clinical decision-making and consumer personalization. With an enterprise master person index, your teams can identify and resolve duplicate records to facilitate the integrity of a single person record. Advanced automation capabilities are available with the HealtheIntent Master Person Management (MPM) API, which can help identify and combine your patient records.

Which venues does Oracle Health Acute Case Management support?

Oracle Health Acute Case Management can add value to any customer, including general short stay acute hospitals and health systems, children’s hospitals, rehabilitation hospitals, and critical access hospitals, as well as behavioral health and development facilities in long-term and post-acute care venues.

Extending Acute Case Management to the post-acute space builds on what’s already available as a product and can be licensed now for use in other venues of care. We’re constantly evaluating use cases for any venue that’s capturing medical necessity criteria and care transitions for the benefit of the caregiver and the safety of the people in the community.*

* All solutions/services are under development. Oracle Health makes no assurances that the capability described herein will be provided in the solution/services.

What positions does Acute Case Management support?

Acute Case Management supports case managers, utilization nurses, documentation specialists, discharge or care transition planners, social workers, and other clinical roles supporting readmission prevention, denials, and appeals, as well as multidisciplinary teams focused on utilization, length of stay, and care transition planning.

What strategic vendors are part of Acute Case Management?

For utilization management, clients can choose to use either InterQual or MCG Health medical review guidelines within Acute Case Management. Medical review guidelines are not sold by Oracle Health. Clients will need a separate license with InterQual or MCG Health prior to embedding content and launching the third-party applications within Acute Case Management.

For care transition planning, Acute Case Management has invested in embedding naviHealth's nH Discharge and Ensocare Transition to support care transitions for patients discharged from acute care and needing post-acute care placement and services. Oracle Health resells the post-acute care transitions (naviHealth's nH Discharge) and post-acute referrals (Ensocare Transition) solution integration and support.

What encoders does Oracle Health support?

Oracle Health collaborates with both Optum and 3M to provide seamless use of their encoder solutions using APIs to communicate data in near real time.

Does Oracle Health offer a computer-assisted coding or clinical documentation improvement solution?

Oracle Health supports standard HL7 interfacing to computer-assisted coding and clinical documentation improvement solutions.

What are the benefits of a clinically driven revenue cycle?

The Oracle Health clinically driven revenue cycle enables administrators, care teams, and coders alike to aggregate clinical and financial records into a single patient record and take advantage of clinical automation to help tackle traditionally manual tasks.

How does contract management integrate with Oracle Health Patient Accounting?

Contract management is part of the Oracle Health Patient Accounting data model and can support both net-down and gross AR reporting. Calculations of expected reimbursement are updated frequently as demographic information, charges, and contracting changes are updated in the revenue cycle system. This way the user has a near real-time view of the applicable contract calculation and terms.

How does Oracle Health Patient Accounting product impact customers on our legacy EHR?

Cerner Patient Accounting has historically been a part of our EHR database infrastructure. With a move to automation, purpose-built data models, and cloud integration components, Oracle Health Patient Accounting will be the new go-forward patient accounting solution. Due to the volume of clients that need to migrate to Oracle Health Patient Accounting, the current Cerner Patient Accounting product will continue to receive support and upgrades, including some of the automation capabilities also available in Oracle Health Patient Accounting. If you’re a current customer interested in more information about Oracle Health Patient Accounting, please reference our FAQs by logging in with your Oracle Health care account. If you’re a new customer, please contact your sales associate to understand how Oracle Health Patient Accounting impacts you.

How does Oracle Health Patient Accounting connect to third-party vendors?

Oracle Health Patient Accounting is designed to be open and extensible. It can use both traditional HL7 interfaces as well as web-based APIs to connect with third parties.

What are the healthcare data exchange services?

Claims management services: Helps produce accurate electronic claims. Range of services includes: claims editing and transmission, claim status, secondary billing, audit tracking and note posting for bill date, confirmation notes, and those items identified in the audit tracking process.

Electronic remittance service: Transforms the administration of payment remittance into a process that targets efficiency and cost-saving. When combined with electronic funds transfer (EFT), it supports faster deposit of payments and cash reconciliation.

ePayment: Aims to accelerate the receipt of payments and connects online payment capabilities with our ePayments service.

Integrated eligibility service: Responds to insurance coverage inquiries that help hospitals, clinics, physicians, and other providers verify coverage details and identify requirements that must be completed prior to care.

Integrated notification, authorization, and referrals: Enables electronic referral and precertification inquiries and sends notifications and referral authorization requests through the integrated notifications and referrals Service.

Lock box service: Automates the remittance and posting process of both insurance and patient payments directly to a healthcare's local bank for more timely recognition of revenue and risk reduction of mishandled/lost payments.

Patient anticipated cost of treatment: Targets increasing collections at or before the time of service by estimating patients' financial responsibility.

Patient-friendly statements: Maximizes the efficiency of your business office and supports patient-friendly communications. Provides data transmission and processing, customized formats, and mailing for statements and collection letters.

Payment assessment services: Addresses verification and payment risk assessment solutions that target efficiencies in the registration, financial counseling, and collections workflows.

Web-based and batch eligibility checking: Healthcare data exchange press is a web-based application, HIS-agnostic, and browser-based eligibility verification solution that automates the delivery of results through the automated batch feature.

What are some of the organizations that healthcare data exchange works with?Healthcare data exchange works with managed care organizations, Blue Cross Blue Shield plans, national commercial plans, regional plans, government plans (Medicare and Medicaid), physicians, physician groups, clinics, hospitals, hospital chains, and integrated health networks. Healthcare data exchange provides electronic data interchange (EDI) services to more than 1,450 of the largest healthcare delivery, acute care, and ambulatory care organizations nationwide, and we currently work with more than 900 payers. Our open network approach enables any healthcare organization interested in participating to join the network while also making it easy to join, both from a business and technical standpoint.

What’s the mission and vision of healthcare data exchange?

Healthcare data exchange’s vision is to leverage the value of data across health networks to facilitate better outcomes. Healthcare data exchange’s mission is to lead the healthcare community in helping to streamline and prioritize standards, integration, and information exchange by delivering software services that aim to connect and elevate the associate, consumer, client, and partner experience.

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