Despite Overwhelming Evidence of Their Positive Impact
According to a recent Black Book (@blackbookpolls) survey, 26% of all U.S. hospitals still do not have a viable, effective Revenue Cycle Management (RCM) solution in place, despite all the evidence of their positive impact on revenue, bottom line and efficiency.
From a marketplace of several hundred core and niche RCM vendors, Black Book survey respondents recently evaluated 165 technology services and solutions. Many vendors offer both software and outsourced business services, while some only focus on one specialty. This report’s results center only on RCM software, technology and Software-as-a-Service (SaaS) solutions.
In 2012, 35% of all hospitals failed to have an RCM strategy to optimize or replace their RCM systems. Six years later, 26% remain without a transition plan. On a positive note, this does indicate that there have been workable RCM IT plans adopted and new systems implemented by about 400 hospitals over the past six years.
Of the 1,600 RCM modernization-delinquent hospitals, 82% anticipate making value-based reimbursement decisions in 2019 without an advanced software implementation or outsourced partner. If forced, 85% indicate they would turn to an RCM consultancy/advisory for short-term direction.
According to HIMSS: The first step in optimizing the revenue cycle is collecting payments in a timely fashion. Nearly 70% of providers report that it takes one month or longer to collect full payment from a patient. The second and arguably most important step is the prevention of claims denials. While claims can be denied for many reasons, the most-likely suspects are two avoidable but often-repeated errors — insufficient documentation and claims defects, both of which can be greatly reduced with a proper RCM system in place.
RCM software applications are usually characterized in two segments: core, platform and/or point solutions; and bolt-on solutions, which provide added functionality to existing core solutions.
The current penetration of RCM solutions for inpatient medical, surgical and hospital environments varies by type of application. Software applications and outsourcing services needed for the core functions of patient registration, scheduling, billing, coding, and claims processing are adopted much more often than some other RCM applications, which vary significantly in penetration across diverse types of hospitals. The following represent aggregate findings from Black Book’s five-month polling process, and details two of the most common issues hospitals combat when dealing with implementing new RCM solutions, or improving existing ones:
- Difficulty in finding skilled RCM human resources for new RCM software/reimbursement challenges; and
- Staffing concerns that make outsourcing core or bolt-on RCM services a better short-term alternative to software implementations.
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. Empirical evidence shows it pays off in the long run.
About Black Book ™
Black Book Market Research LLC, provides healthcare IT users, media, investors, analysts, quality minded vendors, and prospective software system buyers, pharmaceutical manufacturers, and other interested sectors of the clinical technology industry with comprehensive comparison data of the industry’s top respected and competitively performing technology vendors. The largest user opinion poll of its kind in healthcare IT, Black Book™ collects over 450,000 viewpoints on information technology and outsourced services vendor performance annually. Black Book is internationally recognized for over 15 years of customer satisfaction polling, particularly in technology, services, outsourcing and offshoring industries.
Black Book™, its founders, management and/or staff do not own or hold any financial interest in any of the vendors covered and encompassed in this survey, and Black Book reports the results of the collected satisfaction and client experience rankings in publication and to media prior to vendor notification of rating results.
For methodology, auditing, resources, comprehensive research and ranking data, see the Black Book Market Research website or contact research@blackbookmarketresearch.com