Blog Post

Which of Your Costly Revenue Cycle Bolt-Ons Do You Really Need?

Revenue Cycle Bolt Ons Web

Is it time to cut your revenue cycle bolt-ons? Those applications you purchased to support your EHR/revenue cycle core system are not only expensive but may be impacting system efficiency and optimization.

It may have been several years since you implemented your core EHR. At the time, you evaluated the functionality and determined that specialty applications or bolt-ons were needed to operate the new system. Vendors provided a list of additional applications that were required. Some vendors helped you determine which applications can “go away” with the new system. Your organization’s decisions made sense at the time. However, the EHR vendors have improved upon and enhanced the efficacy of their applications or created partnerships with third-party vendors to streamline the interfaces.

Each year, your IT department is asked to take a look at reducing costs. Now is a good time to engage with your revenue cycle colleagues and consider opportunities for efficiency and cost reduction. As the CFO, you probably have had some difficult conversations about your EHR/revenue cycle system and its impact on cash collections.

Almost every CFO has a few battle scars associated with a rough conversion and doesn’t want to experience that again. The table below lists many of the applications that providers have purchased and notes which ones should be evaluated for replacement or retirement.

Application TypeReplace or Retire?
Enterprise Master Patient Index (EMPI)Yes
Document ManagementYes, vendor dependent
Coding SuggestionNo
Kiosk Yes, vendor dependent
278N: IP Admission NotificationsNo
Claims Clearinghouse No
Contract Management Yes, vendor dependent
Patient Statements/Letters No
Eligibility and Benefits No
Electronic Payment Services Yes, vendor dependent
Payment Propensity Not Yet
Address VerificationNo

Let’s go over some of the bolt-ons you should evaluate for replacement or retirement.

Electronic Enterprise Master Patient Index

Many organizations purchased software to overlay the EHR to assist in matching disparate systems between the hospital and independent physician providers or with physicians who are on separate systems. More and more providers are joining hospital EHRs through employment or via a hospital extension of the ambulatory EHR to community physicians. Many of today’s EHR products come with enhanced EMPI capabilities and can accommodate different systems. Taking these factors into consideration, the best path forward for most organizations is to evaluate the functionality of this additional software compared with the EMPI of the EHR. This could represent well over $100,000 in savings for your organization.

Document Management

This is vendor dependent, and you may already have built-in deep integration of document management with the EHR, so splitting this out may not be practical. Data conversions for document management systems require testing but are not that complex. There may be an impetus to evaluate the document management system when your organization transitions to a new system or plans for a big upgrade.


Many organizations developed custom software or partnered with retail vendors to install kiosks in busy waiting rooms. All vendors offer this type of software, but the featured functions vary. There are strong benefits of implementing kiosks that integrate with revenue cycle systems to facilitate copayments or past due collections. The kiosks from a few years ago did not allow for more clinical information and were very tied to online banking. Forward-thinking organizations are allowing patients to update their demographics to include insurance information, which alleviates some of the burden on the front desk and clinical staff. In addition to potentially resulting in FTE cost savings, these kiosks also increase patient satisfaction, as they can provide information that allows clinical staff to focus more on patient care and less on data entry.

Contract Management

Contract management is still an area with mixed reviews. Most revenue cycle vendors offer a contract management solution. However, although some of these systems provide the ability to load in detailed rates and support multiple fee schedules, this information can be cumbersome to update. Further, patient access staff have to choose from a myriad of insurance plans or financial classes to enable some contract management systems to perform effectively. This can cause rework and/or additional FTEs in the back office to spend time correcting errors.

What About the Bolt-Ons You Shouldn’t Replace?

For the bolt-ons we suggest you keep, now is the time to evaluate whether some of them can be consolidated into one contract. There are vendors that offer this option, and your organization may be able to achieve 10% to 20% savings just by renegotiating contracts.

Don’t be afraid to explore opportunities for efficiency and cost reduction within your revenue cycle operations. You may need to rethink certain workflows and must certainly be diligent in testing prior to implementation, but in the end you may reap some rewards–both financial and technological.