AltuMED Smart RCM Engine
A Controlled Revenue Production System
Built as a multi-zone assembly line that ensures every claim is engineered, routed, and optimized for maximum yield. A specialized system that self-improves with every cycle
Revenue Cycles Shouldn’t Be Unpredictable
Most healthcare practices run RCM as a workflow consisting of a collection of disconnected tasks. Major processes like charge entry, coding, submission, posting, and followups work in silos. This workflow offers no meaningful communication between the front desk that gathers insurance info, coders who prepare claims, and billers who handle denials. The resultant high rate of errors leads to unpredictable cash flow and surprise denials. Not to mention, much of the job involves manual efforts, which add significantly to the administrative burden on an already overwhelmed clinical staff
A smart, fully synced RCM system is the best answer to all these problems.
Introducing Smart RCM Engine
AltuMED’s RCM Engine is an innovation that redefines the way you handle your revenue cycle management. This engine works pretty much like an intelligent assembly line that replaces siloed tasks with a structured workflow, which runs in an ideal sequence to get the best possible outcome. It brings accuracy, speed, and predictability to your billing process.
Traditional RCM:
RCM Engine:
How the RCM Engine Works
The main function of the RCM Engine is to plug revenue leaks that occur with a fragmented billing cycle. At the back-end of this function is a 5-stage production line. Each stage handles a particular area of RCM using its embedded intelligence and data from the preceding feeder. Adding to this is strong interconnectivity among all the stages. This forms a synchronous, highly intelligent system that identifies and fixes errors the second they occur.
Now, let’s have a look at all the 5 stages of the RCM Engine.
This step mainly involves data verification to ensure ‘manufacturing’ progresses without any problem. The main aspects of this stage include:
- Structured charge capture that standardizes input data
- Eligibility and data validation that catches errors at the source
- Coding readiness check to ensure documentation accuracy
The embedded intelligence of this layer exists in the form of sensors that detect documentation problems and notify the teams to ensure no unworthy claim moves down the pipeline.
Now, this is where the real intelligence comes into action. This is the stage where the AI scrubber looks further into the claim details. Here is what it does:
- Claim preparation based on payer-specific rules and requirements
- Automated error prevention through validation of codes, modifiers, and therapy units
The native intelligence of this stage gets a complete understanding of the logic behind the payer rules to ensure their precise application.
This stage involves claim routing for optimal processing. It involves:
- Selecting the highest-probability pathway for claim routing
- Claim status tracking in real time to monitor payer response
- Automated handling of payer acknowledgment
The intelligence involved in this stage comes from routing algorithms. These algos select channels based on their velocity and payer behavior patterns.
This stage is all about quality assurance. It checks every received payment by:
- ERA processing and posting to match payments with claims
- Variance detection to spot underpayments
- Payment reconciliation to ensure contract compliance
The intelligence in this layer involves variance analysis to flag underpayments and contract deviations within 24 hours of payment posting.
At this stage, the engine rectifies the denials and accelerates the recovery process for delayed payments. But it doesn’t stop just there. It works like a feedback loop to learn from delays and denials and uses that intelligence to strengthen the process right from stage 1. The core functions of this stage include:
- Denial workflows that forward exceptions to specialized recovery teams
- AR prioritization to queue claims based on their recoverability and value
- Intelligent follow-ups with payers
This layer uses predictive analytics to determine which claims are recoverable and which are not worth appealing.
The best thing about this entire production line is that it evolves. The feedback from the stage 5 helps improve the process at stage 1. This makes the system more efficient with every work loop.
RCM Solution That Works Like A Smart Factory
Continuous Flow
Every claim moves through the RCM Engine’s sequential stages without getting stuck at any point. It doesn’t sit idle, waiting to be finalized by the billing team before getting dispatched. That’s because every stage processes claims the moment it receives them.
Embedded Intelligence
Every stage of the RCM Engine uses its embedded intelligence to process claims. This means instead of dealing with the errors at the bottom of the workflow funnel or after denials, the engine rectifies mistakes right where they originate. This single component turns your RCM strategy from reactive to proactive.
Real-Time Visibility
All stages of the RCM Engine are interconnected and accessible to the main portal. This allows the RCM teams and medical practices to view revenue cycle progress whenever they want.
Feedback Loops
This one is the most interesting feature of the RCM Engine. You may assume that the engine’s main job is to run every claim through specific stages to make it reimbursable. But that’s not all. The system’s built-in feedback loop feeds the main AI algorithm with the claims’ intelligence generated by the stage 5.
Our All-Inclusive Services That Ensure RCM Brilliance
Given what we have established through tech integration, we just couldn’t let RCM services to run manually. It is true that services need complete human involvement. But this is also the area that involves high task repetition. This is why we have combined the best of our human expertise with the best of technological advancements to deliver the best services.
Here is how our ‘Services’ framework operates inside the RCM Engine ecosystem.
This step involves complete claim cycle management. We ensure your claim gets accurately processed right from the initial charge capture all the way to the final payment. This comprehensive service involves the execution of all five stages.
Under the ECM umbrella, all the claims whose payments get delayed or denied for whatever reason trigger a particular system response that we call ‘Exception Handling.’ This special protocol starts processing the problematic claims instantly. It either rectifies a claim on its own or forwards it to the human team if the claim requires a complex rework. What this service strictly avoids is putting the claim in a pile to let it get older and harder to work upon. Quality control and recovery happen at the stage 5.
Traditional RCM practices handle credentialing as a separate operation with a significant administrative burden. They either hire an entire team to run this process (if they are highly resourceful) or delegate it to an office manager. At AltuMED, we solve this problem through our tech stack, which makes the entire workflow convenient for the revenue team. We have streamlined this operation so effectively that we can now guarantee none of your practitioners will remain unapproved.
This one is a very special service. As the name suggests, it essentially audits the bottlenecks of your workflows, inspects wasted revenue, and helps identify improvement opportunities. But that’s not all. It feeds the intel from its audits back into the engine to upgrade the procedural protocols. Not only does this fix individual claims, it also makes the improvement more intrinsic.
Patient collections are usually the most overlooked area of the RCM process. Yet, it controls a significant part of your revenue. The reason practices fail to recover this revenue is that they run a comprehensive claim process and exhaust their workflow before reaching this point. And this ultimately hits back at their bottom line. AltuMED handles this process through automated smart workflows. Patients receive their statements on time and get regular nudges until they acknowledge.
Compliance reporting is a retrospective process that makes a revenue team stop everything and work on disparate measures to ensure they have been adhering to regulatory bodies’ policies all along. This causes a disruption in the usual RCM workflow. AltuMED eliminates this entire administrative hassle by ensuring compliance in day-to-day tasks. Our system also ensures consistent adherence to MIPS quality measures.
Pre-Configured Workflows For Your Specialty
RCM rules vary from one specialty to another. So, every specialty requires a specific workflow that handles its every aspect. This is the very area where most practices and many RCM vendors struggle. They go with generic workflows that do not yield optimal results.
AltuMED’s RCM Engine solves this through specific workflows that are configured to the micro levels to ensure maximum accuracy. At the same time, we understand that no technology, no matter how advanced, can work alone to run a billing process precisely. That is why we always have a highly qualified billing team on board. This is to ensure that there is always a human brilliance driving the machine performance.
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Frequently Asked Questions
About RCM Engine
What is an RCM Engine?
An RCM Engine is a production system for healthcare revenue. Unlike traditional billing software that manages tasks, an Engine processes claims through a continuous 5-stage assembly line with embedded intelligence—similar to how smart factories manufacture products with zero defects and maximum efficiency
How does the assembly line reduce claim denials?
An RCM Engine is a production system for healthcare revenue. Unlike traditional billing software that manages tasks, an Engine processes claims through a continuous 5-stage assembly line with embedded intelligence—similar to how smart factories manufacture products with zero defects and maximum efficiency
How does RCM Engine integrate with my EHR?
An RCM Engine is a production system for healthcare revenue. Unlike traditional billing software that manages tasks, an Engine processes claims through a continuous 5-stage assembly line with embedded intelligence—similar to how smart factories manufacture products with zero defects and maximum efficiency
What's the difference between RCM Engine and traditional billing services?
An RCM Engine is a production system for healthcare revenue. Unlike traditional billing software that manages tasks, an Engine processes claims through a continuous 5-stage assembly line with embedded intelligence—similar to how smart factories manufacture products with zero defects and maximum efficiency
How scalable is the RCM Engine platform?
An RCM Engine is a production system for healthcare revenue. Unlike traditional billing software that manages tasks, an Engine processes claims through a continuous 5-stage assembly line with embedded intelligence—similar to how smart factories manufacture products with zero defects and maximum efficiency
What security standards does RCM Engine meet?
An RCM Engine is a production system for healthcare revenue. Unlike traditional billing software that manages tasks, an Engine processes claims through a continuous 5-stage assembly line with embedded intelligence—similar to how smart factories manufacture products with zero defects and maximum efficiency
Proven Results and Metrics
AltuMED’s human expertise and RCM Engine’s accuracy being significant improvement to your revenue cycle. Here is what you get with us:
97.35%
First-Pass Resolution Rate
30%
Overall Revenue Increase
20-30%
Reduction in AR Delay
30-40%
Defect Reduction
Boost Your Revenue Production Line With AltuMED
Join healthcare organizations that have turned their revenue cycle from a cost center into a profit generator. AltuMED serves healthcare providers across the US. We understand billing regulations and payer requirements in all 50 states.
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AltuMED proudly serves healthcare providers across the United States. We understand regional billing regulations and payer relationships in all 50 states.