Increasing Payer Denials, Uninsured Challenge Hospital RCM

Jake Morris via HFMA

A June survey found that hospital technology budgets continued to grow even as providers struggled to realize the full benefits of existing revenue technology. The Guidehouse/HFMA survey of 125 hospital and health system CFOs found that 90 percent are concerned about consumer self-pay and less than half have established revenue integrity programs. 

Three-quarters of surveyed executives said their RCM technology budgets were increasing, and more than half said they struggled to keep up with electronic health record (EHR) upgrades, said Jake Morris, managing director at Guidehouse. The survey found that 41 percent lacked the means to track the effectiveness of their technology. Only 44 percent had established revenue integrity programs. 

“Revenue integrity should be the glue that binds clinical operations with coding and business office functions,” Morris said. “It’s clear that providers with established revenue integrity programs are benefiting from them; expanding their scope will help yield long-term financial reporting reliability and operational efficiencies.”

Hospitals need to exploit the full functions of their EHRs as they consider new technology spending, Morris said.

“Are they getting the most out of their existing technology? Have they fully optimized everything they have now? They need to focus on account structures and processes,” Morris said in an interview.

Further revenue cycle pressure came in a separate 2018 “Healthcare Outlook,” in which Guidehouse predicted an uptick in uncompensated care after years of decline.

Guidehouse predicted potential cuts to the Affordable Care Act, growing reliance on high deductible insurance plans, and a rise in uninsured populations. 

Morris advised hospitals to tighten revenue cycle functions; implement strategies for rating credit quality to target collection efforts where they’re likely to yield results, and to develop manageable payment plans for households with less income.

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