Providers Want Innovation, Disruption for Revenue Cycle Management

Technology can’t solve all of healthcare’s problems, but providers agree that it can definitely improve revenue cycle management.

In a recent survey conducted by KLAS and the Center for Connected Medicine, top health system leaders agreed that revenue cycle management is the area in healthcare that has the greatest need for innovation and disruption.

Revenue cycle management is overly complex and manual, making it ripe for improvement, the survey report titled “Top of Mind for Top Health Systems 2021” explained. And as providers shift to more complex value-based contracts, the need for innovation intensifies.

But providers have oftentimes faced barriers with revenue cycle management innovation largely because of fragmented technology and a lack of an enterprise solution to reduce the need for third-party and bolt-on solutions.

Health system leaders, which included CIOs, CMIOs, and other executives and directors, are optimistic that revenue cycle management will get the disruption in needs in 2021. About 57 percent of survey respondents said they are confident in the industry’s ability to innovate revenue cycle management next year.

One of the main reasons for optimism in this area was COVID-19.

Some respondents indicated that the pandemic would force healthcare stakeholders to innovate out of necessity. But pessimistic respondents (30 percent) also said COVID-19 has created more urgent needs than revenue cycle management innovation, resulting in a shift in focus for their organizations. They also said a lack of alignment between healthcare’s many players, including the government, payers, and providers, will impact revenue cycle management innovation in 2021.

Meanwhile, the other most cited reason for innovation optimism was the industry shift to more patient-driven care, including the financial experience.

Yet, innovative technologies are more likely to support back-end functions, the survey results suggested.

The top revenue cycle management challenges technology is poised to address included coding (21 percent of respondents), billing and accounts receivable (15 percent), and data sharing and interoperability (13 percent).

But few health system leaders said technology can help address more patient-facing aspects of revenue cycle management, including price transparency (5 percent) and online appointment scheduling (5 percent).

Price transparency, in particular, may be a revenue cycle management challenge current technology cannot help address, according to health system leaders. About a quarter of respondents (24 percent) said technology is not the problem with price transparency, rather government and billing changes are needed to advance price transparency.

Some health system leaders also said current revenue cycle management technologies still do not have the capabilities to accurately estimate patient costs. This may be because of the complexity associated with different insurance coverages, deductibles, and co-insurance, the survey report explained.

But for revenue cycle management challenges technology can help health systems overcome, leaders are looking to solutions with artificial intelligence, predictive analytics, chatbots, and automation. These technologies were cited as the most-needed technologies to improve revenue cycle management.

Revenue cycle management was also one of the most common responses for areas of planned artificial intelligence use, the survey showed. The area was second only to virtual assistant applications.

Other top approaches to improving revenue cycle management technology included focusing on the front-end (e.g., scheduling, check-in, coding), adding business intelligence and analytics capabilities, and consolidating to fewer disparate systems.

The COVID-19 pandemic may impact health system investment in revenue cycle management innovation and disruption in 2021, especially considering the survey finding that health system leaders are still uncovering the revenue cycle management lessons learned from the pandemic.

But COVID-19 has underscored how difficult it is to maintain financial health as a health system and the need to bolster revenue cycle management, the survey report stated.

So, what did the report find is top of mind for health systems as leaders determine digital health priorities in the era of COVID-19?

KLAS and the Center for Connected Medicine said, first, digital health solutions and technology will be key for keeping patients engaged. Second, the pace of innovation will accelerate. And finally, technology will need to support a health system’s ability to react quickly to rapidly changing conditions, including temporary regulations and reimbursement policies that facilitated digital health use during the pandemic.