Are Big RCM Systems Improving Your Bottom Line?
Various surveys indicate that hospitals are struggling with their RCM (Revenue Cycle Management) to improve their bottom line. Hospitals and health systems are finding it hard to make revenues needed in this ever changing healthcare landscape.
Part of the struggle is due to:
A steady stream of mergers
Lack of interoperability
The shift of value-based care
Above, are just some of the concerns that are prompting healthcare systems to improve their RCM.
Dimensional Insight recently surveyed health systems to assess their current tools and challenges within RCM. The results highlight the complexity of tracking and gathering data throughout the revenue cycle, especially for organizations with multiple EMR and/or RCM solutions. RCM is an umbrella under which all revenues are managed and maximized. This process begins with a patient’s first point of contact with a health system and extends until bills are reconciled, usually long after treatment is complete.Patients would pay no co-pays or deductibles and would regain free choice of their doctors and hospital. Doctors would regain autonomy over patient care.
Survey results show a complex combination of issues:
Multiple vendors at work: The survey found most health systems rely, at least in part, on the EMR (Electronic Medical Record) for RCM (Revenue Cycle Management). More than two-thirds (70.9%) use their EMR solutions for revenue cycle management. In addition, most (69.9%) utilize multiple vendors for RCM purposes.
Denials pose the biggest challenge: Denials top the list of health system’ within RCM, with (76.1%). Revenue integrity (36.8%) and patient pay (34.2%) were next on the list. The health systems using multiple RCM solutions often report bigger problems with denials. The highest rates of problems with denials were reported by health systems using their EMR plus one or two other solutions. Denials can only be handled well with effective integration and interoperability.
Disparate sources are a pervasive problem: Nearly all who were surveyed, (98.8%) said collecting data from disparate sources is a challenge for revenue reimbursement.
Bottom Line: It’s pretty clear that there are opportunities for improvement in RCM for health systems. This is a complex set of problems to solve. The right technology can be a big part of the solution for RCM. The human side of workflow will also need to improve. Going forward, health systems need solutions to bring data together and make it useful throughout the entire revenue cycle.
Sources: Dimensional Insight