Why Most RCM Processes Are Backlogged In Medical Centers

 Wayne Carter RCM
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Understand the Reason why Medical Centers have backlogged RCM Processes

In the ever-evolving landscape of healthcare financial management, maintaining an efficient Revenue Cycle Management (RCM) process is not just beneficial—it’s essential for the financial well-being of medical centers. However, many medical facilities find themselves grappling with revenue cycle management backlogs, which can adversely affect revenue flow and operational efficiency. In this article, we’ll explore the reasons behind the prevalent revenue cycle management backlog issue in medical centers and how modern technological solutions can help alleviate these challenges.

The Insight from the Health Revenue Cycle Management Challenges Index 2023

A recent survey, known as the Health Revenue Cycle Management Challenges Index, 2023, sheds light on some of the pressing issues faced by over 200 healthcare providers in managing their RCM processes. This comprehensive survey offers valuable insights into the daily struggles healthcare providers encounter while dealing with RCM, as well as the potential of technological RCM backlog solutions to address these challenges.

The Weight of Claim Denials

One prominent revelation from the survey is the significant burden posed by claim denials for healthcare providers. Shockingly, 40% of the respondents reported annual revenue losses exceeding half a million dollars due to insurance claim denials, underscoring the immense scale of the problem.

While Artificial Intelligence (AI) and Robotic Process Automation (RPA) have proven their effectiveness in mitigating this issue, the healthcare industry appears to be somewhat hesitant in embracing these cutting-edge technologies. Nevertheless, the survey emphasizes the urgency for the entire healthcare sector to adopt these innovative RCM backlog solutions, which have the potential to substantially enhance the revenue of healthcare providers nationwide.

The Backlog Hotspots in RCM

The survey findings point to specific areas within the RCM process where providers are most frequently encountering revenue cycle management backlogs. Claim submission emerges as the stage most prone to backlogs, as reported by 42% of respondents. Other processes that commonly face revenue cycle management backlogs include denial management, patient collections, and prior authorization, all tied at 31%. Patient eligibility and benefits verification follow closely behind at 26%.

The remainder of the top ten RCM processes plagued by backlogs are patient billing, verifying fee schedules and contracts with insurance companies, medical coding, verifying provider credentials, and reporting, with percentages ranging from 9% to 17%. These statistics underscore the multifaceted nature of RCM challenges faced by healthcare providers.

Claim Denials: The Leading Challenge

Claim denials emerge as the top challenge for healthcare providers, with more than 40% of respondents reporting annual revenue losses exceeding half a million dollars due to denied insurance claims. Furthermore, a concerning 18% reported annual losses exceeding one million dollars, highlighting the financial toll of this issue.

The survey reveals that nearly 60% of respondents consider dealing with insurance denials as one of their most significant RCM challenges, while 42% identify denial management as a stage in their RCM process often hindered by staff shortages.

It comes as no surprise that 43% of respondents have identified denial management as a top priority for 2023. Additionally, 20% of respondents have acknowledged that achieving clean claim rates and reducing denial rates are key performance indicators (KPIs) their RCM teams are focusing on this year.

The Staffing Conundrum

Another significant challenge that healthcare providers grapple with is staffing needs. Approximately 40% of survey respondents cited staffing as one of their most significant challenges. Additionally, almost half of the respondents revealed that they rely on external support for RCM, either by utilizing a combination of internal and external teams or by outsourcing to one or more vendors.

The Technological Lifeline

While these challenges may seem daunting, there is a glimmer of hope for healthcare providers. The survey shows that those who have embraced new technologies, such as RPA and AI, have witnessed improvements in their overall RCM process.

Nearly 20% of respondents using AI and RPA noted that their greatest improvement since implementing the technology was enhanced efficiency in filing claims. Moreover, 18% reported a reduction in data-entry errors.

For almost 30% of respondents, AI and RPA translated into faster cash flow and collections. Approximately 20% stated that it resulted in more insightful and readily accessible business analytics.

Bridging the Gap with Technology-Based Solutions

At BillingParadise, we understand the importance of bridging the gap between healthcare providers and technology-based RCM backlog solutions. We recognize that when technology is harnessed effectively, it leads to better patient care and financial outcomes.

Our services, such as claim status-check bots, leverage automation to streamline the claim status-check process, making it more efficient and error-free. Additionally, our automated eligibility verification process empowers providers to assess eligibility before rendering services or submitting claims to payers.

The challenges faced by medical centers in managing their RCM processes are substantial, but the RCM backlog solutions are within reach. Embracing technological advancements like AI and RPA can help alleviate backlogs, enhance revenue, and improve overall operational efficiency, ultimately leading to better patient care and financial stability in healthcare institutions across the country.

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Wayne Carter

I've been working in healthcare industry of the United States in various types of departments since 2013. Started my career from the bottom as a Accounts Receivable executive, Practice management team handler, Entire Practice Management and now I'm employed at BillingParadise as a Content Lead. Areas of Expertise: End-to-End Revenue Cycle Management, Content Writing, Digital Marketing, RCM applications and Software, Healthcare Business Development, Healthcare Sales, and Healthcare Automation.

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