Multiple RCM solutions complicate finances for providers

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Healthcare organizations face challenges in managing their revenue cycles, reporting a complicated environment in which they typically use more than one solution that appears to be making the task more difficult.

A recent survey of provider organizations conducted by HIMSS Analytics found that more than two thirds—68.9 percent—use more than one vendor solution for revenue cycle management (RCM), and those providers with multiple solutions report larger issues with denials.

The HIMSS Analytics study was conducted in tandem with Dimensional Insight, a developer of analytics and data management solutions for complex and highly regulated industries. The company wanted to examine the state of RCM in healthcare organizations. The survey tracked responses from 117 senior level executives in hospitals and health systems, including CEOs, CIOs, CFOs directors of IT and finance, and heads of RCM.

Even as the industry transitions to incentives from value-based care, it’s struggling with the revenue cycle and challenges of getting bills out and payments in, the survey found. Increased patient pay and a spate of mergers are creating new challenges within health systems and, as a result, many organizations are looking for ways to improve their revenue cycle management.

Operating multiple RCM systems apparently has not led to increased efficiency. Disparate sources of financial information has complicated matters—67 percent of respondents reported that lack of interoperability, with some systems left in silos, contribute to revenue integrity issues. On top of that, some 30 percent of key stakeholders say they do not trust the data emerging from multiple systems.

Claims denials are far and away the biggest challenge with RCM, mentioned by 76.1 percent of respondents. Revenue integrity was mentioned by 36.8 percent, and patient pay was an issue for 34.2 percent.

“Many hospitals and health systems are undergoing mergers in hopes of increasing efficiencies. Or they implement several different technologies as band-aids to compensate for the deficiencies of systems,” said Fred Powers, president and CEO of Dimensional Insight. “Unfortunately, what they’re finding in many cases is that the different technology systems in place are hard to integrate, and now this is impacting the bottom line.”

Full results of the survey can be found here.

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