Innovaccer Inc., the Health Cloud company, announced the results of a national “flash” survey of healthcare revenue cycle executives. The report, “The Cascade Effect: How data fragmentation is impacting the revenue cycle,” reveals the top revenue cycle pain points share a common thread: data and process fragmentation that caused nearly 50% of respondents to struggle with prior authorization and nearly 40% to struggle with denials prevention.
More than half (53%) of health systems responding were using four or more data sources and vendors to drive revenue cycle operations, while 76% were using three or more, and 89% were using two or more. A mere 10% of respondents reported they have a unified approach to revenue cycle management (RCM) data and vendors. The result: siloed systems and data fragmentation are encouraging manual processes, causing disjointed workflows, and reducing visibility into the key decision metrics leaders need to optimize revenue cycle performance across the board.
“Data fragmentation and a reliance on old ways of doing things are preventing health systems leaders from optimizing revenue cycle performance,” said Sean Hogan, General Manager at Innovaccer. “Organizations are addressing the effects instead of the cause: data fragmentation that impacts prior authorization, performance management, denials prevention, and more. By unifying their disparate systems and data on the Innovaccer Health Cloud, health systems can transform RCM with a single source of financial and operational truth that lets them integrate, analyze, and optimize the revenue cycle end-to-end.”
Almost half (47%) of survey respondents pointed to prior authorization as one of their top pain points, followed closely by denials prevention (39%), performance management (35%), workflow automation and manual process reduction (31%), and pre-bill claim scrubbing (30%). In fact, all of the pain points with responses over 30% are largely manual tasks in most health systems, because revenue cycle data is scattered across multiple systems, settings, and vendors.
The report cites prior authorization (PA) among several examples of the impact fragmented data can have on administrative overhead and inefficiency. Most prior authorizations are entirely manual, conducted via fax and phone calls. Fully electronic transactions account for only 21% of all prior auths, according to the 2020 Council for Affordable Quality Healthcare (CAQH) Index. Prior auth is also among the most costly processes in healthcare. The HFMA reported prior authorizations cost providers $528 million in administrative overhead in 2019. An ASTRO study of academic radiation oncology practices found some PAs took as much as 95 minutes to process, and had an average annual departmental cost in excess of $491,000.
In addition to helping improve all stages of the revenue cycle, unifying disparate IT systems with an enterprise data fabric can accelerate a health system’s patient engagement strategy, enabling personalized, contextualized patient experiences; and reimbursement innovation at scale in an era of rapid consumerization, intense competition, and eroding margins.
The full RCM flash report, available here, provides quick and timely insights into how the responding health systems structure, manage, and hope to improve their revenue cycle management processes. It also reveals opportunities for driving profitability and optimizing the revenue cycle through increased billing accuracy, reduced errors, more efficient handling of prior authorizations, improved turnaround time, and denials prevention techniques.
