The coming year is full of responsibilities for healthcare providers. Not only is there the approaching deadline for transitioning to ICD-10, but there is also the multitude of incentive programs for EHR adoption, electronic prescribing, quality reporting, among others.All these programs are contending for resources, keeping hospitals which is why many healthcare organizations have been unable to focus on an important component of healthcare delivery, the revenue cycle. “With the focus right now being so much on clinical applications, for the most part those who don’t necessarily have a lot of these systems or have something in place aren’t really focused on any sort of replacement at this time,” says Brendan FitzGerald, HIMSS Analytics Research Director.
The revenue cycle space is pretty broad. It covers everything from standard patient accounting in hospitals to clearinghouses and reimbursement claims and things of that nature. Under the umbrella of the revenue cycle, there are so many different facets that hospitals have to deal with, not only from a software or application basis but just from a payment standpoint — so many hoops they have to jump through essentially to actually collect money.
Selecting and implementing technology to manage these challenges prove a demanding undertaking as well because no technology is capable of addressing all or even of the tasks that are part of the revenue cycle currently.“There is no silver bullet for revenue cycle,” FitzGerald argues. “There are so many different pieces within the revenue cycle process that it’s almost impossible to cover everything, which is why they rely primarily on niche vendors that specialize and have these modules in place and can on some level interface them with primary accounting systems.”This reality explains why healthcare organizations have taken a best-of-breed approach to choosing vendors and products. Traditionally, revenue cycle has been a bit of an à la carte industry and area. We’re seeing a lot of vendors such as Passport, MedAssets, and Emdeon breaking that down a little bit in trying to bundle a lot of the services that they have,” adds FitzGerald.What is clear from the provider’s side of things is who needs to be involved in the decision-making process. Generally speaking, two figures lead the way — the CFO and CIO — with the latter ultimately taking the lead because of the fact that RCM is about information and technology. Even at larger institutions where committees of managers, vice presidents, and other members of finance are convened, the final decision rests with the CIO and CFO.Anywhere that revenue is concerned, the CFO is going to have a hand on the scale and essentially want to be involved, but it’s really the CIO’s area of expertise,” FitzGerald reveals. ” The CFO may have some input on leading the CIO down that path — we need this; we need that — but ultimately it will be the CIO’s decision on what to implement and what road to go down.”
Although most healthcare organizations are more than a year away from making the revenue cycle their primary focus, they will be looking to senior leadership to steer in the right direction when the time comes and the resources are finally made available.
