Revenue Cycle Management

Ease of transition to ICD-10 by October 2014 and improved front-end transactions are high on the checklist for providers who are looking for ways to improve their revenue cycle management (RCM) process, according to experts. One way to tackle this is to have a well-rounded technology suite, they say, and vendors are stepping up to fill that role.
Nancy Fabozzi, Frost & Sullivan Connected Health principal analyst and author of a recent analysis, indicated that revenue cycle processes and workflows are receiving unprecedented attention as hospitals seek to ensure maximum collections in the face of growing financial challenges.
She said that healthcare reform and the push for deficit reduction are forcing hospitals to address long-standing inefficiencies and shortfalls around the RCM process, driving the market for a host of next-generation RCM solutions.
Her research, U.S. Hospital Revenue Cycle Management: Overview and Outlook, 2012-2017,finds the market for RCM applications and services in U.S. hospitals will grow significantly and steadily over the next five years. From the valuation of $1.9 billion in 2012, the total U.S. hospital RCM market is forecast to reach $3.07 billion in 2017, a 61.6 percent increase.
"Most of the efficiencies have been squeezed out of the back-end, and now pushed to the front-end," said Paul Pitcher, research director at KLAS, a healthcare research and reporting company. "There is a trend where vendors are broadening what they offer, from eligibility to other elements that support the front-end process and link to the back-end process."
"We would really like to integrate the front end more effectively with the back end - registration directly feeding the back end so that (providers) get paid every time," he said.
An early trend that is starting to get a little bit of energy is well-rounded suites, offering complete functionality - all bolted together. There aren't many vendors who can provide that, according to Pitcher.
"Passport, Emdeon and Relay Health are big-hitters that could be able to fill (that) need," according to Mike Smith, vice president, financial and services research for KLAS.
"We are seeing providers take a more holistic approach to the whole enterprise and patient end, in clinics and in some cases, post-acute settings," he said. "(Many providers are) in the process of selecting new patient accounting (solutions) - integrated inpatient and outpatient sides to be able to present just one bill to their patients."
Pitcher said other vendors that are starting to look at this and offer rounded out suites include DCS Health, Recondo Technologies and SCI Solutions.
While John Casillas, senior vice president, Business-Centered Systems at HIMSS, Healthcare Finance News' parent company, agrees that the hot products are currently focused on the transition from IDC-9 to IDC-10, he thinks that the patient portal will be one future trend of successful RCM processes.
Engaging the patient, enabling them to see their entire hospital visit will ultimately generate more revenue, he said. "This happens when patients are able able to see their health record, set up payment plans, send reminders, see family history, what they're spending on healthcare and apply for a health loan, all in once place."