Professionals expect the market for healthcare revenue cycle management products to boom, driven in part by changes associated with measures such as the Affordable Care Act. Before things can take off, providers and vendors must work together to address the entanglement of problems that exists in the current RCM structure.
Legacy Revenue Cycle Issues
Healthcare accounting is a bed of complex issues, compliance requirements, and seeping collection troughs. Large organizations struggle to reign in unwieldy accounts receivables; small offices often deal with issues as they attempt to manage revenue via scaled-down software originally designed for hospital environments. At every level, facilities, providers, and payers suffer from the inherent costs of RCM. According to a research analyst at Piper Jaffray, it costs up to 30 cents on the dollar to bring money from the consumer to the provider. The same process costs fractions of pennies in other industries.
Other legacy issues that challenge the viability of RCM organizations include:
- The use of a subsection of companies to manage RCM
- Systems that don’t meet the individual needs of providers or keep up with constantly evolving markets
- The process of placing risk–and, ultimately, reward–on payers instead of providers
Challenges for the Future
Providers and payers are in the throes of a rebirth of healthcare RCM. Regardless of the outcome of the ACA, experts are betting that ideas like bundled payments, accountability, and affordability are planting their feet for the long haul, and organizations will have to shape up or ship out. Culling the dead weight in RCM is one way to ensure an organization is ready to face whatever changes may come in the next few years.
Some specific challenges may include:
- A continuing reduction in allowables as federal payers tighten belts
- Growing demands for transparency, accountability, and compliance
- Increased expenses associated with data security as records migrate to virtual spaces
Innovation, Integration, and Customization
Experts extol the virtues of processes and software that let RCM organizations innovate and customize to meet ever-changing demands. ERM and EHR software that is designed for specific niche needs, but still meet the general regulatory and data compliance requirements of the industry, will become a main stay for all offices. From DIY software that puts RCM power in small offices to enterprise-wide solutions that integrate and simplify payment structures for corporate healthcare companies, forward-thinking solutions are going to be the stars of what some are predicting will be the the next RCM boom.
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