According to a recent Black Book survey of over 4,640 individuals from 522 hospitals and healthcare delivery networks, approximately 26 percent of US hospitals do not have an effective healthcare revenue cycle management (RCM) solution in place. This figure is down from 35 percent of hospitals reporting no RCM strategy in 2012. Without a viable RCM solution in place, hospitals are very likely leaving significant revenues on the table.
While approximately 400 hospitals have adopted RMC plans and new systems since 2012, currently 1,600 hospitals in the U.S. remain without an effective RCM strategy. Of those 1,600 hospitals, 82 percent anticipate making value-based reimbursement decisions in 2019 with no RCM advanced software implementation or outsourced partner with that level of capability.
Optimizing RCM
The first step in optimizing RCM is collecting payments in a timely manner. Nearly 70 percent of providers surveyed reported that it takes one month or longer to collect full payment from a patient, a lifecycle that is often detrimental to the financial health of the care provider.
The second step is the prevention of claims denials. Claims can be denied for many reasons and most often come down to two avoidable errors: insufficient documentation and claims defects. Both can be reduced with RCM solutions in place.
Common Issues with RCM Implementation
Black Book notes 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;
- Staffing concerns that make outsourcing core or bolt-on RCM services a better alternative to large scale software implementations.
From a marketplace of several hundred core and niche RCM vendors, Black Book survey respondents evaluated 165 technology services and solutions. Many vendors offer both software and outsourced business services, while some only focus on one specialty. Black Book’s report centers only on RCM software, technology, and Software-as-a-Service (SaaS) solutions.
Turn the Corner on Lost Revenue
Most hospitals are losing 2 to 5 percent of their net revenue in insurance denials, underpayments, and slow patient collections. In order to maximize revenue and reduce claims take-backs, it is imperative that hospitals 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.
With its comprehensive suite of RCM services, Meduit manages receivables and accelerates cash flow to maximize revenue. Meduit’s RCM experts will assess your organization’s specific needs and develop a robust RCM strategy to recover more money faster. In the era of value-based care, RCM solutions like those delivered by the Meduit team are a must.
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