The healthcare system has experienced significant transformations in recent years, driven by technological advancements and evolving requirements. Amid these changes, the Allscripts RCM tool has undergone a substantial shift, leading to the creation of Veradigm. This evolution has introduced revolutionized features like data analytics, population health management, and value-based care.

As the U.S. healthcare system aims to deliver higher-quality patient care more economically, Veradigm’s integration of real-world evidence allows data collected at the point of patient care to be transformed into actionable insights. Veradigm Payerpath an end-to-end RCM solution, has been recognized for its superior performance, achieving a >98% first-pass clean claims rate and connecting with a network of over 3,100 payers. In this blog, we’ll explore the main differences between the old Allscripts RCM tool and the new Veradigm features and how these changes are reshaping the healthcare ecosystem.

Allscripts RCM: The Traditional Approach

Before diving into comparison, it’s important to understand the significance of Allscripts RCM services in the healthcare industry. In the past, Allscripts medical billing provided a robust solution for revenue cycle management with providing comprehensive EHR solutions. However, the rise of value-based care models and the growing demand for data-driven decision-making demanded a more mature solution-Veradigm.

Pros of Allscripts RCM

• Integration with Allscripts EHR: Integration with Allscripts EHR offered better data sharing between clinical and financial departments. Allscripts EMR also enabled smoother data-sharing between teams.
• Automation of claims and billing: Automation reduced administrative errors and accelerated revenue collection.
• Compliance Features: Built-in tools helped healthcare providers stay compliant with evolving healthcare regulations, such as ICD-10 coding.

Challenges of Old Allscripts RCM

• Administrative burden: Although Allscripts offered RCM and EHR solutions, they were not fully integrated in many cases, especially when deployed as standalone modules.  Allscripts medical billing particularly faced problems when integrated with other EHRs other than that of its own. So, the healthcare staff had to manually coordinate between the EHR and revenue cycle management sides of the business.
• Data consistency: With third-party EHRs and EMRs, ensuring that data remains constant between the RCM and EHR systems was a complex task, as any mismatch in data synchronization could lead to billing errors.
• Inflexibility in Population Health: It focused on individual billing and claims but could not incorporate insights for population health management, which is becoming increasingly important in modern healthcare.

Veradigm: The Modern Approach to RCM

In 2018, Allscripts transformed into Veradigm, that focuses more on data solutions, analytics, and real-world evidence (RWE). Veradigm represents a significant shift and upgrade, along with integrating AI-powered tools. Veradigm EHR’s offerings go beyond the traditional Allscripts RCM system, aiming to optimize not only financial processes but also clinical outcomes through deeper insights into patient data and value-based care models.

Key Features of Veradigm RCM Tool

• Advanced-Data Analytics: Old Allscripts was designed to address issues such as denials and errors after they had occurred, which caused delays in AR. To deal with this, Veradigm introduced predictive data analytic tools that helped healthcare providers improve upon traditional Allscripts AR management by addressing potential claim denials and errors proactively. These measures allow insights into the financial performance of a practice.

• Real-world Evidence Solutions: Veradigm’s RWE solution collects and processes extensive healthcare data, making it easier for healthcare providers and researchers to analyze trends, improve clinical trials, and optimize drug development. Actually, this allows providers to make evidence-based decisions for improving care and developing new therapies. By identifying the most effective treatments, RWE helps avoid unnecessary costs associated with ineffective treatments.

• Population Health Management Integration: Veradigm allows for the integration of population health data, giving healthcare providers the ability to analyze patterns and trends across patient populations, which can improve care delivery and reduce overall costs. 

Differences Between Old Allscripts RCM and New Veradigm

Feature	Old Allscripts RCM	New Veradigm
Focus	Traditional RCM functions: claims, billing, payment collection	Comprehensive data-driven RCM with analytics
Analytics	Basic financial reporting	Advanced predictive analytics for financial and clinical insights. With the Veradigm EMR and EHR, healthcare providers can access real-time data insights
Denial Management	Reactive, addressing issues after they occur	Proactive, using predictive analytics to prevent denials
Value-Based Care	Limited integration with value-based care models	Strong focus on value-based care and real-world evidence. Veradigm’s predictive analytics and RWE offer providers tools to identify high-risk patients earlier
Population Health	Not integrated	Integrated population health tools to improve outcomes across patient populations
Compliance	Basic regulatory compliance features	Enhanced features for adapting to value-based care and data-driven decision-making

Additional Unique Challanges

1. Core and Mission

• Even though Allscripts itself offered both EHR and RCM solutions, in many cases, they were not fully integrated, especially when deployed as standalone modules.  An EHR holds critical information about the patient’s treatment history. In cases where Allscripts RCM wasn’t integrated with the EHR system properly, providers often face issues with data not flowing smoothly between the systems. This meant that healthcare providers had to manually enter patient data in both systems (EHR and RCM), which increased the likelihood of errors.
• New Veradigm focuses on enhancing interoperability with various EHRs through industry standards like HL7 and FHIR, ensuring that different systems can exchange data efficiently without needing extensive customization.

2. Product and Solution Offering

• Old Allscripts offered a lineup of EHR solutions like Sunrise, Professional EHR, and TouchWorks, along with tools for practice management and RCM, as well as basic administrative needs. However, as healthcare systems increasingly demanded data-driven insights, they lacked the depth needed to analyze trends across entire populations or deliver real-world evidence that could support broader healthcare research.
• New Veradigm filled this gap by introducing advanced analytics, RWE solutions like ePrescribe and Connect, and population health tools, empowering healthcare providers to move beyond patient-specific records to actionable insights across patient populations, ultimately supporting more comprehensive care.

3. Customer Base

• Old Allscripts, for the most part, serves healthcare providers, including hospitals, outpatient centers, and clinics. It centers on technologies that support day-to-day clinical operations and patient workflows. 
• Veradigm aims at the back end of the healthcare ecosystem to reach a wide range of stakeholders, from life sciences and payers to government organizations. It also uses advanced data analytics, machine learning, and AI to deliver predictive insights. This technology supports research and value-based care by focusing on decision-making that affects populations rather than individual cases.

4. Data Analytics Capability

• Allscripts didn’t have the capacity for data analytics on a larger scale. This meant that it primarily targets front-line clinical services, focusing on enhancing the quality of direct patient care.
• Veradigm’s solutions leverage the Veradigm Network to provide access to extensive EHR data, enhancing research and analytics capabilities across various healthcare sectors.

Although Veradigm empowers providers with advanced analytics, interpreting and implementing these insights for specific billing and coding improvements can still require specialized knowledge. Transcure’s expert coders and data analysts work alongside providers to turn Veradigm EHR’s analytical insights into actionable steps for more efficient revenue cycles.

Conclusion

The transition to Veradigm is not only an upgrade but a comprehensive solution that allows healthcare providers to take advantage of advanced tools for managing population health, predictive analytics, and getting real-world evidence. This also empowers the professionals to make data-backed decisions and reduce unnecessary costs. However, even with Veradigm’s advanced medical billing software, many experts require third-party expertise to fully utilize its benefits.

With Veradigm RCM, providers can identify potential claim issues before they occur. However, the task of accurately coding each service and ensuring all documentation aligns with payer requirements often still requires a level of precision and attention to detail that goes beyond a single platform’s capabilities. Transcure’s team of coding experts is well-versed in the latest ICD codes, payer requirements, and regulatory updates, ensuring that each claim is not only accurate but also optimized for maximum reimbursement, reducing the risk of costly denials and audit penalties. Transcure enables healthcare providers to capitalize on Veradigm’s insights while ensuring steady financial performance, accurate coding, and quicker reimbursement.

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