Evaluating RCM Technology Through Three Different Stakeholder Lenses

RCM outsourcing and technology go hand in hand. This robust technology can lead to reduced costs and increased revenue collections which is especially important in light of new hospital margin data included in Kaufman Hall’s March 2023 National Hospital Flash Report showing that relatively flat margins are likely to continue in the near term.

These flat margins are just one reason why revenue cycle outsourcing is on the rise.

Just how much on the rise? Recent research from The Health Management Academy (The Academy) states 93% of health systems rely on at least one strategic RCM outsourcing partner.  Of those, 36% stated they would consider extending their relationship to a full enterprise partnership to take full advantage of integrated RCM technology platforms that offer streamlined workflows, intelligent automation and unparalleled accuracy.

RCM technology and industry challenges

Another reason why RCM outsourcing  is on the rise is because many health systems have learned their internally built technologies can no longer keep up with the speed of technological advancements. This fast-changing technology, coupled with the ever-changing complexities of revenue cycle management means an increase in providers looking for a partner whose sole focus is RCM, especially one who can combine people, processes and technology into one robust revenue cycle solution.

Thinking about the above challenges in addition to automation and sophisticated analytics, are important when looking for an RCM outsourcing partner. However, it’s also important to take a close look at how revenue cycle management technology can provide specific and concrete benefits to common problems affecting three different stakeholder groups: health systems, patients and staff.

Stakeholder 1: Health systems

Addressing patient leakage

Healthcare administrators are all too familiar with the problem of patient referral leakage… a patient walks in for a physician visit and walks out with a referral for a diagnostic test or physician follow-up, but the follow-up never happens. And if the patient does follow-up, there is no guarantee they will choose to receive care at the same health system or move to a competitor.

According to Healthcare Finance, the resulting loss of revenue is astounding. They report that almost 90% of healthcare leaders say patient leakage is a major issue. They also report that most organizations use their electronic health record system to track leakage but are not satisfied with the results they are getting. Most concerning is that many executives report leakage is costing their organization up to 20% in lost revenue – the equivalent of millions of additional dollars that are being left on the table. Coupled with this is the fact that without proper tracking and monitoring of patient referrals, many patients never even follow-up in their care, which can hurt the overall patient experience and their overall health. A robust RCM technology system can help address these issues.

R1 provides intelligent patient experience tools that enable providers to submit referrals and signed orders electronically to make patient conversion faster and more consistent – and make the health system a referral destination of choice. This same tool also reduces administrative burdens associated with manual referral processes such as sending faxes and making follow-up phone calls, which frees up staff time to handle more complex patient issues.

By identifying gaps within your health system – such as patient leakage – healthcare executives have a starting point for finding a revenue cycle outsourcing partner to help them fill those gaps and improve their overall business model.

Stakeholder 2: Patients

Putting patients in the driver’s seat

Patients are used to technology designed to make their life easier: online shopping, online banking, online bill pay, the list goes on and on. The healthcare industry has been slow to follow this tech trend, but one of the few benefits of the COVID pandemic is that it sped up the industry’s adoption of patient-facing technology.

Why does this matter? It’s simple. Patients need options that can simplify their financial and bill pay experience. Patient-facing tools serve a dual purpose: they benefit the patient by making their financial experience better, and they also improve the propensity to pay.

When looking for an RCM outsourcing partner, keep in mind that patient-facing financial tools should extend far beyond just making it easier to pay. A full financial suite of options such as simple and easy to understand price transparency tools, bill consolidation options and customized payment plans should all be considered when vetting a revenue cycle partner.

R1’s patient-facing technology puts patients in the driver’s seat and solid patient satisfaction scores are the result. In fact, clients who utilize R1 Entri Pay^TM are seeing an average net promoter score (NPS) of 45. On the provider side, revenue performance is up with an average of 40% increase in net-new cash.

Ensuring prior authorizations get done faster 

Another way to look at RCM technology through the lens of the patient is to explore the benefit that can come from automating the prior authorization process.

Obtaining a prior authorization quickly and easily is especially important when a high-end imaging test or costly medication is needed. Oftentimes the medical stakes are high, and it can be a stressful time for patients.

Currently, most insurance prior authorizations are done manually, a slow and costly transaction that can result in patients having to reschedule important tests or services due to the authorization not being received in time. This delay can cause a frustrating patient experience, not to mention a delay in care.

Industry leaders are working to encourage the use of automation in obtaining prior authorizations. R1’s patient engagement platform addresses the prior authorization challenge by providing embedded standardized and optimized workflows to make the process more streamlined and efficient. This intelligent automation process can provide patients with faster medical care and reduce administrative burdens and their associated costs.

Stakeholder 3: Staff

Labor shortage and administrative burdens

Most healthcare industry experts will tell you the labor shortage extends far beyond the clinical staff. In fact, in a recent survey, 90% of healthcare executives stated they are experiencing a labor shortage in their RCM/billing department. Additionally, nearly half stated 50% of their RCM/billing roles are currently vacant.

As these revenue cycle positions remain unfilled, time-consuming administrative burdens, including manual billing, coding and insurance verification, increase. These burdens not only increase the chance of human error – including billing errors – they also slow down patient service, both of which can result in a negative patient experience.

RCM automation can reduce many of the administrative burdens that cause these problems. Another benefit to RCM automation is that it frees up staff so they can provide a higher quality of patient service or focus more time on complex revenue cycle problem solving, both of which can also benefit the patient experience and employee satisfaction by providing growth opportunities.