Healthcare Facilities Yet to Implement a Full-Fledged Revenue Cycle Management Solution

 Erika Regulsky Tags: , , , , , , RCM, value-based reimbursement
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Without a viable revenue cycle management system, the survey says, “82 percent hospitals will overlook value-based reimbursement and 85 percent may opt for consulting services.

According to a new Black Book survey, nearly one-quarter of healthcare facilities in the US haven’t yet implemented a full-fledged revenue cycle management solution.

It surveyed nearly 4,640 individuals from 522 hospitals to know if they had enabled any of the 165 RCM technologies and solutions available. Although there were marginal improvements happening, many of these hospitals were yet to implement the RCM solutions in its entirety.

26 Percent of Hospitals without Transitional Plans

replacement plans

The survey further states that 26 percent of the hospitals did not have transitional plans. Either to optimize or upgrade revenue cycle management systems. In one of the most recent surveys, nearly 400 hospitals in the past six years implemented optimization or replacement plans.

None-the-less, there are deficiencies in the healthcare revenue cycle management that still remain and need to improve, the survey added. Over 1600 hospitals did not have plans for any kind of optimization. But, 82 percent of them will finalize decisions on value-based reimbursements in 2019. They would be doing so, without aided by any of the advanced software or outsourced partner.

The traditional fee-for-service system is making way for value-based-reimbursements. The Health Care Payment Learning and Action Network (LAN) in a recent report stated that the proportion of healthcare payments that tied to an alternate payment model is on the rise. It would reach 29 percent of healthcare payments very soon.

Value-based Reimbursement the Preferred Option

alternative payment models

As public and private payers implement alternative payment models, most likely value-based reimbursement is going to be a preferred option to lower cost and improve care quality. The clinical and financial risks associated with the payment models will certainly exist, but hospitals expected to deal with it.

Hospitals, in order to transit to value-based reimbursement, will first need to implement a seamless revenue cycle management system.

Using Powerful Analytics Tools to Compare Data

powerful analytics tools

Healthcare providers using powerful analytics tools can compare clinical data with financial data. An overview of the results can help improve quality.

In changing reimbursement and care delivery models, and for the implementation to be successful, the payers need to get providers and consumers on the same page. For that purpose, next-generation analytics can be useful to put all efforts into practice.

Until hospitals do not implement an efficient revenue cycle management system, the transition to value-based-reimbursement will result in loss of revenue.

With emerging challenges, 85 percent of respondents in the Black Book survey said they will consult revenue cycle management experts or advisory companies for directions on a short-term basis.

Hospitals to Collaborate with Vendors for RCM Optimization

legacy financial and clinical systems

In order to deliver value-based reimbursement, hospitals, in the long run, will have to collaborate with third-party vendors for optimized revenue cycle management solutions.

Elaborating on how hospitals could invest in core, platform, and/or point solutions which cover enterprise-wide functions. The Black Book further explained that bolt-on solutions to automate specific components of the healthcare revenue cycle. And it can be implemented by hospitals.

Bolt-on solutions seem to be the preferred choice of hospitals to complement their legacy financial and clinical systems. The Black Book survey found that 45 percent large and community hospitals might use multiple bolt-on solutions for revenue cycle management in 2019.

Using one core legacy vendor for a software solution had limited patronage – few hospitals expected to use them. The survey pointed out that only 23 percent of small hospital staff, 15 percent of community hospital staff, and 17 percent of large hospital staff favored relying on a core solution as organizations revenue cycle management strategy for 2019.

Hospitals Facing Staffing Concerns

challenge hospitals

The Black Book report claimed that hospitals are investing more in bolt-on solutions than core software because of staffing concerns. According to the report, the five-month polling process revealed the challenges. The biggest faced were staffing concerns, besides implementing new revenue cycle management solutions or upgrading legacy software.

Skilled revenue cycle management human resources were difficult to find. Hospital administrators felt that as a short-term alternative, outsourcing core functions or implementing bolt-on services was a key solution.

Concluding the market research, the Black Book states “if hospitals are to maximize revenue and reduce claims take-backs, it is imperative that those still behind the curve find a way to dedicate appropriate resources toward implementing an effective RCM system”.

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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