More than 1/5 of revenue cycle leaders outsource outpatient services

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About 22% of revenue cycle leaders who manage their inpatient revenue cycle management already outsource some of their outpatient RCM, and 12% have ambitions to do so in the future, finds a new survey conducted by the Healthcare Financial Management Association.

The findings demonstrate a growing interest in digitally transforming outpatient RCM to improve efficiencies, optimize revenue and alleviate a growing administrative burden.

With the COVID-19 pandemic came a greater emphasis on community outreach and an expansion of outpatient services. As outpatient revenue increases and hospitals navigate unprecedented staff shortages, RCM services that leverage multifaceted digital transformation and employ an experienced third-party team become increasingly critical to ensure that financial responsibilities are being met efficiently, effectively and in a compliant manner, survey authors found.

Organizations that outsource RCM are generally very satisfied with their outcomes, and those that are most likely to outsource one function are more likely to outsource more, results showed.

The most challenging aspects of RCM not currently being addressed include denials and appeals management, prior authorization and payer relations. Meanwhile, the top three business drivers that guide one's approach to outpatient RCM include patient experience, process optimization and revenue generation.

WHAT'S THE IMPACT?

Outpatient claims are one of the more complicated aspects of health system RCM, often too full of errors, missing information and inefficient processes to submit a clean claim. Hospital RCM teams have the difficult task of keeping up with growing regulatory changes and frequent fluctuations in hundreds, if not thousands, of payer plan-specific coverage policies, leading to lower cash collections and misreported revenue adjustments.

There's a long-held belief that nearly all health systems use EHR RCM modules for their outpatient RCM. Survey respondents revealed otherwise, with about 25% indicating they use a purpose-built RCM solution for their outpatient or ancillary billing rather than their EHR. 

A purpose-built RCM solution not only increases visibility into key outpatient RCM metrics that can inform critical financial decision-making and reduce revenue shortfalls, but also manages and optimizes these complex claims to minimize the burden on in-house RCM teams, authors found.

The survey results are based on the responses of nearly 160 U.S.-based HFMA members, most of which are revenue cycle management leaders at large healthcare systems.

THE LARGER TREND

An April survey revealed that a majority of revenue cycle leaders are concerned about significant challenges around deployment of CMS' price transparency regulation. The regulation stipulates hospitals must provide clear, accessible pricing estimates online for at least 300 different shoppable services.

The survey revealed the majority of respondents are concerned that significant resource investment will be needed to sustain price transparency and indicated there is widespread confusion regarding the expectations and needs required by the regulations. More than half of survey respondents said they were concerned the implementation and build-out of price transparency systems would continue to eat up valuable resources.

ON THE RECORD

"There is pressure on hospital teams to effectively manage expanding outpatient sources of revenue and expenses," said Bill Voegeli, head of custom research at HFMA and president of Association Insights. "Many of today's healthcare financial and RCM teams lack the necessary time, information and/or staff resources to fully understand the opportunities or implications for RCM automation beyond their electronic health record. Our research with XIFIN gives credence to the notion that healthcare finance professionals will benefit by staying up-to-date about ways to optimize the growing area of outpatient RCM and gives RCM executives insight into new avenues for optimization."
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com