Top 8 Scale Healthcare Alternatives

Given the widespread healthcare staffing shortage, many providers today use software and outside services to optimize their revenue cycle. Some providers seek comprehensive or “end-to-end” solution partners to handle all revenue cycle (RCM) tasks, from verification of patient eligibility, patient payment estimates, charge capture, claims, billing, A/R, and denials.

Those who only need support in one or two of these areas select “point solutions.”  RCM point solution providers are experts in select tasks. Healthcare organizations that want to avoid getting locked into one company for many financial tasks tend to prefer point solutions. More, because point solutions focus on limited RCM tasks, the accuracy and proficiency they deliver often outstrip what the end-to-end solutions can offer in those specific areas. 

Another differentiator among RCM solutions companies is the form of the solution. Some companies primarily offer proprietary software. Others combine software with managers and consultants, and outside – often offshore – revenue cycle staff, or a combination of all three. Scale Healthcare uses its proprietary software along with its healthcare consultants and offshore human resources to provide full-spectrum revenue cycle and business management services. 

What is Scale Healthcare and what markets does it serve? 

Scale Healthcare provides healthcare revenue cycle and business management advisory services, staff, and software to healthcare provider platforms, hospital systems, and healthcare-focused private equity groups.

The company consults on topics as diverse as corporate strategy, growth, transformation, performance improvement, and transaction services. Additionally, they offer managed services for revenue cycle, finance and accounting, compliance, and payer contracting. They also design workflows and plans to enhance healthcare management performance.

In addition to providing guidance from their expert consultants, they can fill gaps at multi-site healthcare organizations with offshore human resources. They claim that “offshoring RCM reduces administrative burdens and improves cash flow.”  

Scale Healthcare can take over the entire revenue cycle or fill in with staff as needed. Their Fully Managed Services put their professionals and staff in place to manage end-to-end departments and functions. Their Staff Augmentation model lets healthcare organizations augment existing teams with highly skilled Scale Healthcare team members.  

Software solutions

Scale Healthcare offers automated software solutions that:

• manage and reduce claims denials manage 
• optimize payer contracts
• perform data analytics on the revenue cycle, as well as marketing, physician compensations, and clinical operations

It also builds custom software solutions tailored to the specific needs of any multi-site client. A custom approach ensures that the software fits the complex workflows and operational requirements for large organizations.

In addition to custom software builds, Scale Healthcare also integrates third-party software solutions to ensure comprehensive service delivery. This includes working with established software for electronic medical records (EMR), customer relationship management (CRM), and enterprise resource planning (ERP) systems to optimize and streamline healthcare operations. 

These integrated solutions and their ability to customize and blend both proprietary and third-party software give Scale Healthcare a unique edge in the market, allowing them to offer comprehensive, tailored solutions to their clients.

Scale Healthcare’s Services

Consulting

Scale Healthcare’s consultants support the healthcare team in their corporate strategy, as well as overall performance improvement and growth. They conduct assessments in operational, clinical, organizational structure, and business services across departments. They evaluate opportunities to improve integration there. In healthcare’s shifting landscape, they have implemented new structures for healthcare organizations and even MSOs.  

Data Analytics

Among other tasks, Scale Healthcare sets up platforms for denial management that include dashboards that provide weekly insights on key performance metrics, as well as reporting. It recently created a credentialing business intelligence application to better track provider credentialing status across payers. 

Finance

Scale Healthcare assesses MSO and healthcare organization financial performance to find revenue leakage and opportunities for improvement. It also provides financial staff to help organizations execute on financial plans. 

Payer Strategy

Experts in payer contract management, Scale Healthcare helps healthcare organizations and MSO overcome payer resistance in cases of rate reductions, unfavorable contract terms, and coverage agreements. It aggressively negotiates rates and terms for clients. Its assessments uncover enhanced reimbursement opportunities and opportunities for expansion with payers in value-based environments. These improvements strengthen market positioning.

RCM

From fully managed outsourced RCM services to addressing points in the revenue cycle like payment posting, credit balance management, billing and claims solutions, Scale Healthcare streamlines and optimizes the revenue cycle for healthcare organizations and MSOs based on their unique needs. 

Talent & human resources

Scale Healthcare places both temporary and permanent CFOs and CEOs into healthcare systems, hospitals, and MSOs. Its VP of RCM placements are backed up by Scale Healthcare onshore and offshore RCM staff. 

Digital Transformation

Given the widespread staffing shortage, healthcare organizations are increasingly automating much of their RCM and operations tasks. Scale Healthcare ushers manually-dependent healthcare organizations into the digital era by providing RCM data analytics, as well as denials and contract management automation software. Its consultants also provide guidance and solutions for IT strategy, IT department architecture, cybersecurity, and cost management. Its process automation services guide you in selecting the best EMR, RCM software solutions, and clinic operations protocols. t. 

By combining their software solutions and services with their professional expertise, Scale Healthcare aims to “accelerate growth and elevate management performance across healthcare services.”

List of 8 Top Scale Healthcare Alternatives

• MD Clarity
• TriZetto
• Change Healthcare
• R1 RCM
• TruBridge
• Health Here
• AZZLY
• Dentrix

RCM Software for MSOs that fuels cashflow acceleration and underpayment detection

MD Clarity

Description

MD Clarity has delivered accurate, proven revenue cycle solutions for over 10 years. A social-impact-driven software company, MD Clarity serves forward-thinking provider groups, health systems, and managed service organizations. Today’s price-sensitive patients want to access accurate medical charges both before their procedures and throughout their medical journeys. MD Clarity’s Clarity Flow aggregates co-pay, co-insurance, and deductible information so that they know their financial responsibilities up front. Greater pricing transparency enhances both patient experience and provider revenue. 

MD Clarity’s software solution RevFind uncovers all payer underpayments and provides organizations with the tools to spot trends and capture significant revenue. RevFind also makes comparing payer rates simple so that providers can pinpoint their best payers and aggregate the data that supports their cases for higher reimbursements. 

Take a quick, self-guided tour through a powerful contract management and underpayments recovery tool:

MD Clarity has worked with 150,000+ providers and 3,000+ facilities to deliver accurate patient pay and good faith estimates that comply with federal privacy and compliance regulations. These automated estimates have facilitated 20,000,000+ patient encounters across the United States.  MD Clarity supports dozens of specialties. G2 reviewers have given MD Clarity an average of 4.8 / 5 stars.   Recently, Built-In recognized it as a Best Place to Work. 

MD Clarity features in common with Scale Healthcare

While MD Clarity and Scale Healthcare both optimize the healthcare revenue cycle via front- and back-end administrative improvements, they have distinct approaches. 

Scale Healthcare takes a fully custom approach, analyzing an organization not only for the automation that may improve its revenues and workflows, but for the gaps in staff weighing it down. Its recommendations include strategy that involves software and the addition of its experts and/or its offshore staff. 

MD Clarity’s business model, on the other hand, promotes its automation software as the quickest, most cost-effective route to revenue capture, increased upfront collections, and payer contract management and optimization. Software automation gets revenue-enhancing RCM tasks completed at a fraction of bringing in outside RCM C-Suite directors and off-shore specialists conducting manual work. When a provider group or MSO already has revenue cycle management professionals in place, it only takes a software solution to improve contract optimization and patient eligibility verification and good faith estimates. 

RCM point solutions that unlock revenue

Patient payment or good faith estimates

Scale Healthcare does not have software engineered to address the growing patient payment estimate issue. It can only offer specialists to generate these estimates manually. While these specialists may be adept at compiling a patient’s co-pay, co-insurance, and deductible information and getting it to the patient, they are more expensive than software. 

MD Clarity excels at streamlining and automating the process of providing patient payment estimates. The Clarity Flow system automatically conducts eligibility checks, generates customized estimate letters for different patient groups, sends estimates when appointments are booked, manages care deposit collections if necessary, and ensures the seamless transfer of collected funds to your organization’s account. With these steps executed via software, neither internal nor external employees are required in most cases. If an estimate is considered an “exception,” MD Clarity automatically forwards it to the provider for manual processing. Typically, only a few estimates need manual handling each month.

This level of eligibility and estimate automation not only reduces the need for repetitive tasks among staff but also helps curb the necessity for additional hires, significantly easing the operational burden on healthcare organizations.

Contract management

Due to heavy workloads, providers often struggle to keep up with their contracts. A recent MGMA poll revealed that 33 percent of providers do not review their contracts annually, and 17 percent report never reviewing them. We've encountered clients who haven't reviewed their contracts for five years or more.

Contract management software centralizes and digitizes contracts, updating them with changes from payers as they occur. Contract awareness is crucial because payers frequently underpay providers and implement new changes without provider approval. Typically, these new terms and fees benefit the payers, not the providers.

Underpayment recovery

Underpayments are often overlooked due to the labor-intensive process of tracking and addressing them. Both Scale Healthcare and MD Clarity use their contract management modules to identify payer underpayments. MD Clarity’s tool, RevFind, compares actual payments to those listed in payer contracts, alerts staff to discrepancies, measures contract performance, and analyzes denials. These steps allow your staff to explore payer resources and report underpayments without relying on expensive specialists.

Automated underpayment discovery works in real-time, continually alerting providers to trends that can lead to significant revenue recovery. RevFind also helps optimize your chargemaster. Its work queues feature assigns appeals and investigations to team members based on your settings, allowing users to review their task statuses in one place, thus centralizing work progress.

Once RevFind digitizes and parses all the terms and fees from your payers, it generates contract performance reports. This competitive intelligence helps you negotiate better fees and contract terms.

Denials Management

RevFind identifies the origins and categories of denials within your organization, enabling you to address root causes and improve processes to prevent future denials. Its detailed reports highlight the specific codes and payers responsible, assisting your team in pinpointing and resolving the factors that lead to revenue losses.

Ratings

MD Clarity has earned an average of 4.8 / 5 stars on G2. 

A Scale Healthcare RCM competitor with end-to-end services

TriZetto

Description

TriZetto, a Cognizant company, provides healthcare IT solutions, including software products and services that help healthcare organizations improve operational efficiency, manage costs, and enhance the quality of care. Their offerings include revenue cycle management software, claims processing solutions, and various managed services.  tailored to meet the needs of healthcare providers, payers, and other healthcare entities.

TriZetto leverages Cognizant's extensive global delivery network to provide offshore staffing solutions. With this staffing arm, it offers managed services, support, and other operational tasks to enhance efficiency and reduce costs for healthcare organizations. Its consultants help healthcare organizations connect disparate systems, standardize data and enable secure, authenticated access in real-time.

TriZetto serves specialized healthcare entities in addition to hospitals, health systems, and insurers.  

Features TriZetto shares with Scale Healthcare

Like Scale Healthcare, TriZetto assures providers that they will provide end-to-end RCM automation using both software and trained specialists. They cover these areas of the revenue cycle:

• Claims management
• Analytics
• Billing and coding 
• Rejection and denials management
• Patient engagement
• Contract management
• Credentialing

To meet patients' demands for full pricing transparency,  Trizetto also offers Patient Responsibility Estimations. These estimates not only fully apprise patients of their financial responsibilities, they enhance upfront patient payment contributions, keeping more accounts out of write offs and bad debt. Additionally, their contract management tools uncover underpayments and include some contract modeling features. Contract modeling ensures providers can determine the financial impact of changes in pricing or contract terms on their overall revenue.

Ratings

TriZetto has an average rating of 4.3/5 stars on G2.  

An API-forward Scale Healthcare competitor 

Change Healthcare / Optum

Description

For over a decade, Change Healthcare operated as an independent entity in the healthcare sector until its acquisition by United Healthcare in 2022, after which it integrated into Optum, its partner organization. Change Healthcare is renowned for its comprehensive range of revenue cycle management (RCM) solutions, serving a diverse clientele that includes specialty physician groups, hospitals, and healthcare systems. Its offerings include:

• RCM analytics that leverage data to identify trends and improvement opportunities
• Self-service clearinghouses that optimize the claims processing workflow
• Tools designed to ensure healthcare services are accurately compensated, securing proper reimbursement

In addition to its software, Change Healthcare employs an API platform. This platform comprises rules and protocols that enable various software applications to interact, facilitating the integration of different systems for smooth data and function exchange. APIs allow developers to leverage existing services and platforms to create new applications or enhance existing ones without starting from scratch. They act as conduits between systems, ensuring interoperability.

Beyond its software, Change Healthcare offers specialized services in billing, prior authorizations, charge capture, and more, adopting a dual approach to tackle revenue cycle challenges faced by healthcare organizations. This "software plus services" model ensures comprehensive coverage for all patients, including managing "exceptions" that the software does not process.

Change Healthcare and Scale Healthcare overlap

Similar to Trizetto, Scale Healthcare and Change Healthcare both offer technology and services for eligibility verification, coding, billing, contract management, and analytics. However, Scale Healthcare does not provide patient pay estimate software, Clinical Decision Support Mechanisms (CDSM), or software that facilitates charge capture, and analytics-driven claims management.

Both Scale Healthcare and Change also provide consulting and advisory services to their clients.

Ratings

Change Healthcare and Optum both have scores of 3.7/5 stars on G2.

A Scale Healthcare competitor known for outsourced revenue cycle management

R1 RCM

Description

Initially founded as Accretive Health in 2003, the company rebranded to R1 RCM in 2017 and is now headquartered in Salt Lake City, Utah. R1 has become a significant player in the revenue cycle management sector, primarily serving hospitals and healthcare systems. Both R1 RCM and Scale Healthcare target a broader audience of large entities, including hospitals, health systems, and physician groups across the United States, encompassing all medical specialties.

Scale Healthcare and R1 RCM similarities:

Comprehensive RCM Solutions: Change Healthcare, Scale Healthcare, and R1 RCM integrate software solutions with a digital workforce and seasoned consultants to efficiently manage a wide range of RCM tasks.

Patient Engagement Tools:  R1 RCM supports patient interactions by consolidating processes such as registration, intake, verification, payment estimates, scheduling, and payment into a single unified tool.

R1 RCM has one review giving it 0/5 stars on G2.

A Scale Healthcare alternative that provides outsourced RCM consulting

TruBridge

Description 

Founded in 2013, TruBridge focuses on serving rural and community hospitals. Its comprehensive suite of software tools is designed to improve the revenue and operations of these often struggling rural entities. Its tools ensure coding compliance, and improve patient engagement. Central to TruBridge's offerings is its holistic RCM software, which includes live analytics and functionalities aimed at increasing revenue cycle efficiency, streamlining billing processes, and reducing staff workload.

In addition to its software, like Scale Healthcare, it also offers consulting services and human resources. 

TruBridge and Scale Healthcare both target large hospitals and complex healthcare systems.  

TruBridge's services encompass:

Claim Scrubbing and Submission: Detects and corrects errors in claims before submission.

Denial and Audit Management: Manages denied and audited claims to expedite payer reimbursements, with automation boosting staff productivity and reducing repetitive tasks.

Contract Management: Helps recover underpayments and ensures contracts are up-to-date to safeguard financial health.

Patient Pay Estimations: Provides patients with upfront information about their financial responsibilities and payment options.

Electronic Health Records: Maintains accurate records and data to reduce denials and prevent misunderstandings.

Staffing: Offers support to restore and maintain organizational stability.

These services are designed to address the primary challenges faced by healthcare facilities in rural and community settings.

Features similar to those of Scale Healthcare 

Scale Healthcare’s software and services for eligibility, coding and billing, compliance, and contract management are similar to Trubridge’s. In addition to these RCM services, however, Scale Healthcare offers business management services like finance and accounting and performance improvement. 

Ratings

TruBridge has a rating of 3.4/5 on G2.

A Scale Healthcare alternative that specializes in behavioral health centers

AZZLY

AZZLY sets itself apart as an RCM provider dedicated exclusively to the behavioral health and addiction treatment sector. Beyond standard RCM automation, AZZLY offers EHR and practice management solutions, integrating three critical aspects of efficient organizational management. This comprehensive approach enables staff at behavioral health centers to focus on patient care. While AZZLY provides consulting services, it does not offer specialists to conduct RCM tasks such as prior authorization, billing, coding, or contract management on behalf of clients.

Neither Scale Healthcare nor AZZLY currently offers a patient payment estimate software solution, though AZZLY has announced that this feature is "coming soon." Additionally, AZZLY has not yet introduced prior authorization automation. However, both companies provide services covering eligibility verification, coding and billing, compliance, contract management, analytics, and credentialing.

Azzly has 3.9/5 stars on Capterra.

A Scale Healthcare competitor that serves high-value provider networks

HealthHere

HealthHere, a dental software company, was founded in 2013. The company is dedicated to enhancing dental organizations by improving patient access and revenue cycle efficiency, primarily through its comprehensive suite of software tools. These tools facilitate smoother operations, including mobile patient intake, cost estimation, automation of episodic payments, various payment options, and the collection of patient-reported outcomes, all of which support the transition to value-based care.

HealthHere oversees dental organizations' transition to a value-based care model by modernizing patient access and revenue cycle efficiency. Its automates payment models, streamlines patient payments, reduces wait times, and elevates patient-staff interactions while lessening staff workload.

Their comprehensive software suite ensures smoother operations through mobile patient intake, cost estimation, automation of episodic payments, various payment options via a patient portal, and the collection of patient-reported outcomes to assess satisfaction and quality, thus advancing value-based care objectives.

The software suite features include:

• Flow: A mobile patient intake solution that, along with in-clinic kiosks and tablets, automates the intake process and reduces congestion at the front desk.
• Q Code: Provides pre-service and good faith cost estimates.
• Qub: Manages automated episodic payment models, streamlining payment processes, pricing, and automation.
• Pay: Enhances patient payment processes through a patient portal offering various payment options and standardizing communications from pre-check to post-procedure to minimize patient confusion.
• Pro: Collects patient-reported outcomes, capturing data on patient satisfaction and quality, which are essential elements of value-based care and go beyond just financial metrics.

Ratings

No reviews exist for the relatively new HealthHere. 

A Scale Healthcare alternative built for dental practices

Dentrix

Description

Founded in 1985, Dentrix Dental Systems became part of the renowned dental and medical supply company Henry Schein in 1997. Dentrix, recognized as a pioneer in dental practice management software, led the market by introducing the first Windows-compatible version in 1989 and soon after secured an endorsement for Windows 98. The software became popular among dental professionals for its ability to optimize dental practice workflows and increase revenue. Dentrix distinguished itself by integrating financial and clinical information into a single, streamlined process.

Features

Dentrix’s solutions include:

• RCM: Features designed for billing and collections enable dental offices to track patient eligibility and process insurance claims efficiently. Dentrix offers tools to generate and send billing statements, expedite payment collections, and manage transactions made with debit and credit cards.
• Clinical: A comprehensive platform that allows dentists to view a wide range of 2D and 3D images, centralizing patient records for easy storage, documentation, and access to information.

Ratings

Dentrix has 4.3/5 stars on Software Advice and GetApp.

Explore MD Clarity’s revenue improvement solutions 

For provider groups and MSOs looking to streamline good faith or patient payment estimates and recover payer underpayments and denials, MD Clarity can help. Clarity Flow automates estimate generation and dispatch, and RevFind automatically finds and flags the payments that fall short of contracted rates. RevFind also measures contract performance, rendering the competitive details that help you negotiate better contract terms and fees. Dedicated to healthcare transparency, MD Clarity enhances patient access to pricing information while improving providers' net revenue.

Schedule a demo to see how Clarity Flow and RevFind can improve your revenue and optimize your contracts. 

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