Upgrades in pre-authorization, bill estimation prompt RCM swaps

Healthcare organizations are intent on replacing or purchasing new revenue cycle management systems (RCM) for upgrades in pre-authorization and bill estimation, according to a new study from HIMSS Analytics.

A survey of more than 500 organizations also found a high level of adoption for functions including determining eligibility and scheduling, but plenty of work yet to be done with charity screening and propensity to pay.

"We wanted to provide granularity around functions used in the Inpatient RCM arena, including how hospitals are approaching those functions and how large of a role they play in conducting transactions on an annual basis," HIMSS Analytics research director Brendan FitzGerald said in a statement. "As the industry continues to change, a move toward vendor solutions by hospitals could help ease the burden of keeping up with financial regulations and help organizations move toward more seamless revenue cycle transactions."

The study focused on eligibility, address verification, scheduling, registration, medical necessity, pre-authorization, bill estimation, cashiering, charity screening and propensity to pay.

Cash flow remains a critical concern for hospitals and physician practices, as well as reimbursements change. Moody's Investors Service, in a recent report, concluded that hospital expenses are outpacing revenue for the first time in several years, and that the trend is "unsustainable."

The $2.4 billion hospital market for RCM software and services is expected to increase by double digits in 2014, however, according to Black Book research. It said hospitals' rush to swap out their RCM systems has slowed--roughly two-thirds of hospitals that in 2012 predicted they would replace their core RCM solution in 24 months have yet to come up with a plan to do so.

RCM replacement is struggling for priority amid an array of technology projects, including Meaningful Use and ICD-10.

Black Book also advised that upgrading software to more fully integrate RCM, practice management and electronic health records may be the key to helping thousands of physician practices remain independent.

To learn more:
- find the report


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