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One-Quarter of US Hospitals Lack Effective RCM Solution

More than one-quarter of US hospitals do not have an effective RCM solution in place, according to a recent survey by Black Book Research.


Source: Thinkstock

By Fred Donovan

- More than one-quarter of US hospitals do not have an effective RCM solution in place, according to a recent survey by Black Book Research.

Of the hospitals that don’t have an effective RCM product in place, 82 percent said they anticipate making value-based reimbursement decision next year without an advanced software implementation or outsourced partner. If required, 85 percent said they would use an RCM consultancy or advisory firm for short-term advice.

This compares with close to one-third of US  hospitals failing to have an RCM strategy to improve or replace their RCM systems back in 2012, Black Book noted in a press release. In 2018, 26 percent of US hospitals still did not have an RCM transition plan.

The Black Book report focused only on vendors that offer RCM software, technology, and software-as-a-service (SaaS) solutions.

The survey found that 70 percent of healthcare providers take one month or longer to collect full payment from a patient. While claims can be denied for many reasons, the most likely suspects are two common errors: insufficient documentation and claims defects.

The 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 hospitals.

Two of the most common problems hospitals face when trying to implement new RCM solutions or improve existing ones are:

  • Difficulty in finding skilled RCM personnel for new RCM software/reimbursement challenges
  • Staffing concerns that make outsourcing core or bolt-on RCM services a better short-term alternative to software implementations

If hospitals want to maximize revenue and reduce claims take-backs, those who are lagging need to find a way to dedicate appropriate resources to implementing an effective RCM system, the report judged. 

According to another Black Book survey, more than one-third of US hospitals said they wanted customized integrated health systems, including RCM, EHR, and practice management (PM) functions.

The survey found that 40 percent of large hospitals plan to replace multiple medical practice systems with integrated ambulatory technologies that interoperate with the EHR and RCM systems by the end of 2020.

Most respondents said that nonintegrated EHR and practice management systems don’t enable them to design alternative reimbursement and payment methods for improved physician engagement and patient care.

Eighty-five percent of integrated delivery network executives said that the alignment of hospital and physician IT meets the challenges of accountable care and value-based payment models.

Hospital-owned and employed physician practices using an integrated EHR, PM, RCM platform collect more than one-quarter more on billed charges on average than do independent practice physicians with nonintegrated or unconnected EHR and RCM platforms.

Ninety percent of hospital networks achieved greater scheduling satisfaction within two months of implementing an integrated platform, the survey found.

“In a healthcare system dominated by large, integrated healthcare delivery organizations, centralized administrations are moving to achieve harmonized electronic health records, reimbursement systems, and quality measures,” said Black Book Managing Partner Doug Brown.

“With over 50 percent of US doctors receiving their pay directly or indirectly from a hospital system organization, CFOs and CIOs are seeing the value-based care model potential, reimbursement improvements, and resources expenditure savings to be gained by implementing a fully integrated healthcare information technology system,” said Brown.


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