The state of revenue cycle management

healthcare enterprise imaging

Dimensional Insight and HIMSS Analytics recently surveyed healthcare organizations to ascertain the state of revenue cycle management (RCM). The survey’s results validate what rev cycle managers already know:

  • Denials are the biggest RCM challenge for health systems today.
  • More than two-thirds of health systems use more than one vendor for RCM.
  • Organizations using more than one vendor report bigger issues with denials than those using one RCM solution.
  • Nearly all respondents say collecting data from disparate sources is a challenge.
  • More than 95 percent of health systems say the way data is collected is a challenge.1

Siloes are for grain

The majority of health systems surveyed indicated that collecting data from disparate sources is a challenge for revenue reimbursement.2 Survey respondents also listed no fewer than 15 different systems – from EMRs to niche solutions – they use to manage the revenue cycle.

There is no “one solution to rule them all” for the revenue cycle. Health systems will have multiple applications and often multiple vendors. The key is to make sure those solutions can talk to each other so that data securely flows across systems to provide users access to the information they need when and where they need it.  Solutions that drive the flow of data via workflows further expedite processes.

While addressing this lack of system interoperability has been prioritized (and rightly so) on the clinical side of the house, it’s woefully behind on the administrative side. It’s not only your clinicians who need access to a complete view of patient information to make informed decisions. Staff on the administrative side of the house do, too, and the demand for better system integration and improved technology tools is palpable.

More systems, more problems

The lack of interoperability produces a myriad of challenges – many of them highlighted in the survey – but most importantly, it’s the root cause of poor financial health, as the resulting issues all negatively impact an organization’s bottom line.

Without the ability to collect data, monitoring financial performance is difficult. Health systems indicated that poor data collection impeded their ability to monitor revenue cycle processes, citing their inability to track performance, billing errors, keep up with variances and identify trends.3 Survey respondents who managed their revenue cycles using their EMRs and one or two other solutions also reported the highest rates of problems with denials.

However, with between 30 and 40 percent of denials due to registration errors4, interoperability isn’t the only issue. Data integrity begins at patient registration and health systems must also look at ways to improve how they’re capturing data.

(Hint: Stop handing patients a stack of intake forms and a clipboard.)

The time is now

A great deal of attention has been given to optimizing clinical systems, but that same attention is now necessary to course-correct how healthcare organizations have been managing – or mismanaging, as the case may be – their revenue cycles.

1, 2, 3 Dimensional Insight, HIMSS RCM Survey: Understanding Health Systems’ Revenue Cycle Management and Challenges, May 2018

4 HBI Academy Research, Registration Errors Significantly Impact Reimbursements

Julie Fogel

Julie Fogel

Julie Fogel joined Hyland in 2011. A member of the content marketing team, this SCUBA-diving, rock-n-rolling, baseball-loving storyteller currently covers healthcare. She also frequently appears in or provides voice talent... read more about: Julie Fogel

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