Healthcare providers in the US incur the highest share of total expenditure (~25%) on administrative activities in comparison to their peers in other countries, and Revenue Cycle Management (RCM) activities account for a major proportion of this expenditure. A majority of this spending is wasteful, driven by broken payer-provider information exchange processes – attributed to relatively low technology penetration, manual intensive operations, and untrained staff.
These legacy issues, coupled with emerging challenges such as rising out-of-pocket expenses and a regulatory push toward transparency, are further adding to the woes of healthcare providers as they firefight newer inefficiencies in RCM processes. Having lagged in technology investments for a long time, health systems, hospitals, and physician practices are gradually adopting digitally enabled modular solutions to revamp their RCM operations. In fact, healthcare providers are quickly realizing the benefits of putting technology at the forefront to solve their RCM issues by collaborating with third-party service providers.
This viewpoint studies the various RCM challenges, describes technology solutions, assesses their benefits to mitigate those challenges, and illustrates ways in which healthcare providers can utilize third-party support.
Scope
Industry: healthcare provider (RCM)
Geography: US
Contents
In this paper, we:
Scrutinize the key factors contributing to revenue cycle inefficiencies across front-end, mid-office, and back-office RCM operations
Make a case for digital elements such as automation, analytics, platform, the cloud, and wrapper tools in alleviating RCM challenges
Describe the benefits of these digital solutions across the RCM operations value chain
Outline the issues that healthcare providers face in in-house RCM investments
Recommend strategies to collaborate with third-party service providers for efficient and outcome-driven RCM processes
