Revenue Cycle Issues

While most large health systems are fairly profitable, they face continual price and revenue pressures, primarily from government payers.  And increasing numbers of people covered by high-deductible plans means that health systems face complex efforts to collect what consumers owe for services.  A survey sponsored by Navigant and the Healthcare Financial Management Association looks at the revenue cycle management challenges for health systems.   (Navigant Report)   The survey included 125 health systems.  74% said their revenue cycle management IT budget is increasing, with the largest areas including revenue integrity, clinician documentation, analytics and EHR workflow and reporting.  50% of the systems say their organization can’t keep up with EHR upgrades and fail to maximize the potential of those systems.  CFOs are more pessimistic about optimization of EHR functionality than are revenue cycle managers.  The most common methods for measuring the value of revenue cycle IT are return on investment and overhead reduction, but 40% of respondents had no standard method for such an evaluation.  Revenue integrity is a focus because of compliance concerns and to ensure that revenue leakage does not occur.  44% of systems say they have a comprehensive revenue integrity approach, with the primary benefits being an overall increase in revenue collection, 68% of systems, and a reduction in compliance risks, 61% of organizations.  While 95% of respondents had an inpatient clinical documentation integrity solution, on 35% had one for outpatient services.  Health systems are struggling to find the right technology for patient engagement and consumer self-pay, although 93% have an online payment portal and 63% have cost estimation tools.  Only 14%, however, have advanced software to help them determine a patient’s likelihood of paying.  92% of systems say the trend toward greater patient payment responsibility will have a moderate to significant impact on their organizations.  As providers strive to maximize revenue collections, consumers and payers will be affected and will deploy their own technology to ensure accurate billing and payments.