What’s a Financial Management or RCM Challenge That Not Enough People are Talking About and Why?

While there seems to be an endless wave of new technologies and solutions that could greatly benefit our organizations, none of them matter if we do not have the funds to adopt and support them. So let’s turn our attention for a moment to financial management and RCM to see what our current challenges are in those areas. At the past HFMA Conference, we asked our incredible Healthcare IT Today Community – what’s a financial management or RCM challenge that not enough people are talking about and why? The video below is a compilation of their answers.

Jeff Surges, CEO at RLDatix
We’re rooted in patient safety and a lot of people talk about patient safety but they don’t know there’s an ROI to it. It’s clearly mission-driven and we all want to be safer in healthcare, but if we take a look at the staffing and the workforce, and we start looking horizontally across many departments the input in the data starts to tell us opportunities for revenue and opportunities for cost savings and efficiency while keeping patient care safe.

Todd Doze, Chief Executive Officer at Janus
I would say denials is always a hot topic for everyone – it’s usually top of mind for most providers. But what I think is interesting that not enough people are talking about is the waste, the administrative function of providing the clinical diagnoses for encounters, and the administrative side of getting bills out the door and getting them paid correctly. One thing that Janus is really focused on today is applying AI to automate much of the administrative function that goes into that workflow.

Ryan McPherson, VP of Commercial Strategy at Cedar
It may be implicit with the fact that we’re announcing these benchmarks, but I would say ultimately the outcomes that your patients are experiencing from a financial perspective with your health system. Many health systems, rightfully so, pay a ton of attention to the insured book of their businesses – it constitutes the majority. But whether you are a digital healthcare provider or a large, firmly established, multi-billion dollar system we truly think that there’s a need to really understand how your patients are experiencing your health system from a financial point of view. We know that historically, up to four and ten patients are deferring care as a result that they had a negative billing or negative financial experience with providers around the country. We think that in order for you to develop effective strategies, techniques, or tactics to addressing these challenges that your patients are experiencing it first starts with understanding how are you performing with respect to your peers. So, we couldn’t be happier to be launching this benchmarking effort.

Geneva Schlabach, Co-Founder and CEO at Vispa
This might be surprising to you, but I believe the thing we’re not talking enough about is people. We talk about people, process, and technology in our industry all the time. I’m the CEO of a technology company but it still takes people to execute, to implement, to get people on board, and get people excited about the new automations that are out there. What we’re seeing is there’s a lack of focus on people and because of that sometimes innovation and automation get stifled. So if we can make sure that we’ve got the right people in the right place, doing what they do best – all the way from ideation to implementing it – we’re going to have a lot more success.

Bob Chin, CIO at PayMedix
I can think of one that is very current, very recent, which is that our EDI Claims Clearinghouse Network in our country can, in fact, be at risk again. I’m sure everybody’s aware of the outage that happened starting in February, our organization has struggled with it as has many other payers and providers. We don’t think that this is going to be the last that we’ll see – it may not even be the worst, although that’s hard to believe. I think the entire community has to really be prepared to protect themselves and to make sure that if something like this happens again that there is a backup, that there is another way to actually get claims from place to place. That’s definitely something that we have to do something about.

Josh Robinson, Revenue Cycle Executive at Signature Performance
I would say, this one’s easy for me just because it’s where my passion lies, it would be credit balances. I know they’re the sexiest part of healthcare – these negative accounts that sit around, inflate books, and confuse things. I’ve been talking about credits for the last decade and I think I’ve brought some awareness to these accounts but the concept is – focus on your credit balances because it might feel like you’re spending money to get said money back or that you’re not preparing the way that you should on those accounts or focusing on them, but the focus pays off. You’re often times over refunding, allowing too many retractions, etc. So, credit balances, focus on those credit balances – that’s what I would suggest.

Brenton Hood, COO at ilumed
Considering the last quarter of last year all of us got hammered by fraud waste and abuse – I think that’s something that needs to be talked about in more detail and how the government’s going to help find what we catch.

Huge thank you to Jeff Surges, CEO at RLDatix, Todd Doze, Chief Executive Officer at Janus, Ryan McPherson, VP of Commercial Strategy at Cedar, Geneva Schlabach, CEO at Vispa, Bob Chin, CIO at PayMedix, Josh Robinson, Revenue Cycle Executive at Signature Performance, and Brenton Hood, COO at ilumed for taking the time out of your day to come and speak with us! And thank you to all of you for taking the time out of your day to read this article and watch this video! We could not do this without all of your support!

What’s a financial management or RCM challenge that you think not enough people are talking about and why? Let us know either in the comments down below or over on social media. We’d love to hear from all of you!