Revenue Cycle Management (RCM) refers to a complex financial process used by healthcare facilities to manage the flow of revenue in an efficient manner. As the market of RCM continues to grow at a rapid pace, new challenges and pressures appear and need to be addressed to ensure the hospital’s growth and financial stability (Glaser & Ziac, 2018). In particular, healthcare providers are required to comply with continuously changing governmental regulations and meet the adjusting needs of the market. According to MGMA Staff Members (2019), the broad scope of RCM involves various areas requiring “the keen attention of a practice leader, from ensuring eligibility information as a frontline defense against claims denial to point-of-service collections for patients with high-deductible health plans (HDHPs)” (para. 1). Overall, the three current challenges that revenue cycle management faces include the claim process monitoring, staff productivity issues, as well as lack of visibility into data.
Monitoring the claim process is a broad issue since multiple entities pursuing different goals are involved in insurance claims. As a result, the error margin increases throughout the cycle if there is a lack of control over all procedures. The findings of the poll conducted by MGMA Staff Members (2019) have revealed that a majority of healthcare leaders that participated in the survey named “claims payment” as their biggest revenue cycle challenge (para. 2). Furthermore, the respondents shared that capturing and sending claims in a timely manner, as well as navigating the constantly changing rules, present a significant problem (MGMA Staff Members, 2019). At the same time, automated alerts and a well-designed IT system can help address this challenge and improve the claim process along with the entire RCM.
Staff productivity is another challenge resulting from a number of factors. In particular, insufficient resources and training, increased workload, and employee turnover can hinder the revenue cycle and affect the company’s financial performance (Glaser & Ziac, 2018). As reported by MGMA Staff Members (2019), employment issues are critical, and “recruiting adequate and qualified revenue cycle staff” is needed to ensure that patient data is processed correctly to avoid improper billing, medical coding, and filing of insurance claims (para. 7). Furthermore, many facilities lack a comprehensive approach to track and analyze employee performance and productivity data which prevents them from improving human resource management. To address this challenge, it is necessary to evaluate staff productivity, promote automation and savings, and improve the workflow in the organization.
Finally, a lack of visibility into data can be viewed as another challenge that Revenue Cycle Management faces. As mentioned above, monitoring staff productivity is an example of a practice that can provide valuable insight to improve financial outcomes. As MGMA Staff Members (2019) report, “claims denial” is a major problem that can nonetheless be addressed by evaluating denial trends and other relevant metrics throughout the cycle (para. 1). Transparency and data visibility can be improved through the use of appropriate technology and reporting practices, resulting in informed decisions and enhanced productivity.
In conclusion, the rapid market growth and changing industry-wide needs present a number of challenges for Revenue Cycle Management. In particular, organizations face such issues as poor monitoring of the claim process, low staff productivity, and lack of visibility into data. At the same time, these challenges can be addressed by promoting automation, using appropriate technology, evaluating employee performance, and improving reporting practices and the organization’s workflow.
References
Glaser, J., & Ziac, V. (2018). Surviving a revenue cycle system conversion. In J. P. Glaser (Ed.), Glaser on Health Care IT (pp. 43-47). CRC Press.
MGMA Staff Members. (2019). Healthcare leaders point to their biggest revenue cycle challenges. MGMA. Web.