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Hospitals Aren’t Getting Much ROI From RCM Technology

Posted on July 24, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

If your IT investments aren’t paying off, your revenue cycle management process is clunky and consumers are defaulting on their bills, you’re in a pretty rocky situation financially. Unfortunately, that’s just the position hospitals find themselves in lately, according to a new study.

The study, which was conducted by the Healthcare Financial Management Association and Navigant, surveyed 125 hospital health system chief financial officers and revenue cycle executives.

When they looked at the data, researchers saw that hospitals are being hit with a double whammy. On the one hand, the RCM systems hospitals have in place don’t seem to be cutting it, and on the other, the hospitals are struggling to collect from patients.

Nearly three out of four respondents said that their RCM technology budgets were increasing, with 32% reporting that they were increasing spending by 5% or more. Seventy-seven percent of hospitals with less than 100 beds and 78% of hospitals with 100 to 500 beds plan to increase such spending, the survey found.

The hospital leaders expect that technology investments will improve their RCM capabilities, with 79% considering business intelligence analytics, EHR-enabled workflow or reporting, revenue integrity, coding and physician/clinician documentation options.

Unfortunately, the software infrastructure underneath these apps isn’t performing as well as they’d like. Fifty-one percent of respondents said that their organizations had trouble keeping up with EHR upgrades, or weren’t getting the most out of functional, workflow and reporting improvements. Given these obstacles, which limit hospitals’ overall tech capabilities, these execs have little chance of seeing much ROI from RCM investments.

Not only that, CFOs and RCM leaders weren’t sure how much impact existing technology was having on their organizations. In fact, 41% said they didn’t have methods in place to track how effective their technology enhancements have been.

To address RCM issues, hospital leaders are looking beyond technology. Some said they were tightening up their revenue integrity process, which is designed to ensure that coding and charge capture processes work well and pricing for services is reasonable. Such programs are designed to support reliable financial reporting and efficient operations.

Forty-four percent of respondents said their organizations had established revenue integrity programs, and 22% said revenue integrity was a top RCM focus area for the coming year. Meanwhile, execs whose organizations already had revenue integrity programs in place said that the programs offered significant benefits, including increased net collections (68%), greater charge capture (61%) and reduced compliance risks (61%).

Still, even if a hospital has its RCM house in order, that’s far from the only revenue drain it’s likely to face. More than 90% of respondents think the steady increase in consumer responsibility for care will have an impact on their organizations, particularly rural hospital executives, the study found.

In effort to turn the tide, hospital financial execs are making it easier for consumers to pay their bills, with 93% of respondents offering an online payment portal and 63% rolling out cost-of-care estimation tools. But few hospitals are conducting sophisticated collections initiatives. Only 14% of respondents said they were using advanced modeling tools for predicting propensity to pay, researchers said.

Hospital CFO Insights from Craneware Summit

Posted on October 22, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I had a chance to attend the Craneware Summit in Las Vegas. The Craneware Summit gives me a nice view into what’s happening in the financial world of healthcare. The Summit kicked off today with Todd Nelson speaking about the hospital CFO. Here’s a look at some of the insights he offered:


Todd Nelson is a former hospital CFO that is now a VP at HFMA.


Is this equation too simple?


I don’t think that meaningful use money will go away, but it’s worth considering. Would your organization survive if the rest of the meaningful use money were pulled out from underneath you?


This is often forgotten. It’s “easy” to get the billion dollar EHR implementation budget, but many forget to include the ongoing EHR support and optimization budget. In my experience this is often just bad planning, but in a few cases it’s done deliberately in order to allow the EHR project to go forward. They figure they can always ask for the support and optimization budget later.


This was an interesting comment coming from an accountant and former hospital CFO. He was willing to admit that he doesn’t have the skill or at least the desire to be the actuary for the hospital. However, as we shift to value based reimbursement, hospitals are going to have to become good at actuarial analysis.


Todd Nelson also extended this comment by saying that you can survive a long time even with losses as long as you have the cash. If you’ve worked with a hospital CFO, you’ve probably seen the cash focus first hand. That hasn’t and probably won’t change.


This is great advice as hospital executives evaluate how to approach the changing healthcare reimbursement environment. Hope is not a strategy.

Improving Financial Performance By Accelerating Cash Flow

Posted on July 24, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she’s served as editor in chief of several healthcare B2B sites.

In IT circles, revenue cycle management isn’t the sexiest assignment, but collecting revenue is the lifeblood of your hospital nonetheless. In this e-book, Relay Health offers several suggestions for speeding up cash flow by being proactive about when and where cash is collected.

Right now, as the book notes, hospitals rely on collecting co-pays at the time of service, while determining and collecting the balance post-service. However, the likelihood of patients paying goes down after they leave the hospital.

To address collections pre-service, Relay Health suggests hospitals use technology to screen patients for eligibility for benefits and their propensity to pay bills, verify their personal data and identity information to avoid fraud and speed the claims process, and screen them for charity assistance.

There’s also several steps the e-book recommends which can increase the propensity of patients to pay post-discharge, including leveraging patient data to customize statements with relevant messages; using visually-appealing statement formats; offering online bill  payment and management; and integrating an estimation/verification tool to help focus the discussion of patient responsibility.

Another important step  hospitals can take is to evaluate their claims management processes and shift effort to areas where the greatest impact can be felt, the book suggests.  As of the first half of 2012,  the average service-to-payment velocity industry wide was 45.3 days from patient discharge to resolution. This can be helped by finding process delays in key areas of claims performance, including service to release of claim, service to submission of claim, submit to Transmit and Transmit to Payment, Relay Health suggests.

Still another way in which hospitals can improve their revenue cycle management performance is to engage in comparative analytics, benchmarking their financial performance to improve decision-making.  The e-book notes that while traditional benchmarking presents several issues — not the least of which being that comparing performance indicators between organizations may be an “apples to oranges” comparison — benchmarking using comparative analytics avoids these issues.

Ultimately, the e-book notes, healthcare providers will transition from a focus on internal data repositories for performance information to a more outward-facing, patient-centric model integrating data from claims, EMRs, PHRs, analytics technologies, CRM systems and health insurance exchanges. In the mean time,  it suggests, it’s definitely worth the effort to fine-tune RCM systems using the data you have.