Introducing Ritten RCM

Imagine you buy an EMR, but you can’t use it for billing. This hypothetical would be a non-starter in most healthcare specialties. Unfortunately, it’s the norm in behavioral health, especially at more acute levels of care. Providers often use separate software platforms for managing claim submission and clinical note-taking. To make matters worse, there’s usually a third platform for patient invoicing. Why is this the status quo? Because it’s hard to build both a robust clinical note-taking system and a revenue cycle management system all in one platform. It’s often easier for software companies to partner with RCM vendors, or acquire dedicated RCM solutions and stitch them together with an existing EMR. This challenge of building a truly unified platform motivates us. We love working on the hardest, but most important problems. Building a single application EMR/RCM that does both things well is one of those problems. It’s complex, but it’s also incredibly valuable to behavioral health programs. Let’s explore why.

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Behavioral health billing requirements are unique. It is not the case in behavioral health that a single appointment is always billed as a single claim with a single supporting note, as is the case in most other specialties. Each session could be a group or an individual session. For a group, not only does one appointment result in many notes and then many claims but each member of the group could have a different CPT code for the associated claim and so each claim itself would look different and have different documentation requirements. Furthermore, a given service line for a client might (but not always) consists of multiple appointments and notes if they are getting billed per diem. In this way, you can have a single group note that drives billing in a number of different ways for the clients in that group. In a typical two-system EMR-RCM setup, the only link between the two systems is the information on the claim form itself. This data lacks critical information needed for potential validation and follow-ups from a billing team, including which sessions (maybe multiple) are associated with that claim. For example, it’s impossible to know what the total time of service is, how many members were in a group, etc. without navigating between two systems trying to reconcile notes to claims.

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Next, there are typically many billing-related data points that are relevant for administrative or clinical users in the EMR, but these are rarely supported by billing system integrations. For instance, scheduling staff may want to flag a client with a high balance prior to making an appointment, or providers may want to surface client invoices or other billing information in the same portal that a client uses to complete clinical forms. In both cases (and many more), separate EMR-RCM systems, even with an integration, typically provide a disjointed experience for providers and their clients. A unified platform can seamlessly surface RCM data in the EMR in ways that directly improve the client experience.

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Lastly, configuration and support can be much more challenging with two separate software systems. This is especially relevant for the small and medium size businesses that provide most behavioral health services, who don’t typically have dedicated system admins or IT staff. With two different systems, even when integrated, there is often feature redundancy, making it hard to know which part of the workflow or setup happens where. This redundancy can cascade into the support process, with each vendor having limited ability to troubleshoot the other’s issues. This is frustrating when a provider just wants to get their problems solved and their software working smoothly.

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With these benefits in mind, there’s no question that building a combined EMR-RCM platform is a worthwhile pursuit. The bigger question is one of execution - is it feasible for a software company to be able to build and manage both products effectively? We believe that with our enduring organizational focus on exceptional engineering and product design, we can. In fact, with strongly positive feedback from our pilot RCM users, we already have. We’re excited to release this platform more broadly in the coming year. It will bring us closer to our ultimate goal of developing the behavioral health “operating system” for our customers and provide a more seamless, efficient experience for providers and clients alike.

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Ready to experience the future of digital healthcare? Book your demo today!

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