Hospitals and health systems are struggling to make the most of their revenues in the ever-changing healthcare landscape. A steady stream of mergers, lack of interoperability, the shift to value-based care, and other challenges are prompting health systems to focus on improving their revenue cycle management (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. Here are some of the survey’s highlights and as well as a few thoughts on what they mean for health systems.
The survey, conducted in early 2018 by Dimensional Insight and HIMSS Analytics, asked 117 C-suite and other senior decision makers 12 questions about their RCM. RCM is an umbrella under which all revenues are managed and maximized, a process that begins with a patient’s first point of contact with a health system and extends until all bills are reconciled, usually long after treatment is complete.
“Coordinating this complex combination of business processes, systems, and humans resources — so many people with different skills — is a significant challenge,” says George Dealy, Dimensional Insight’s vice president for healthcare applications. Survey results show the pain points.
Multiple vendors at work
The survey found most health systems rely, at least in part, on the EMR for RCM. 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. This is true of health systems that leverage their EMR for RCM and those that use other solutions.
Denials pose the biggest challenge
Denials topped the list of health systems’ challenges within RCM, with 76.1% naming denials as the biggest challenge. Revenue integrity (36.8%) and patient pay (34.2%) were next on the list.
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