Exclusive Report: Data and Trends to Help Health Systems Combat Top Revenue Cycle Challenges and Stop Revenue Leakage

May 25, 2023 | By Kyle Hicok

Rising costs, labor shortages and shrinking margins are market challenges Chief Financial Officers and Vice Presidents of Revenue Cycle partners repeatedly express. They need a way to combat these obstacles wreaking havoc on their revenue cycle, causing them to lose millions of dollars.  

With many health systems continuing to struggle with razor-thin or near-zero margins, there is opportunity to provide tremendous relief and it involves taking a careful look at all the critical steps of the RCM engine, with patients’ evolving needs at the forefront.  

Through our work with 95 of the top 100 US health systems, we understand that delivering an optimal revenue cycle in its entirety is not an easy feat. Yet when done correctly, an intelligent revenue cycle can support financial outcomes, improve the patient experience and establish a more efficient and sustainable RCM journey. 

To help address these roadblocks, we have developed the 2023 Revenue Intelligence Data and Insights Report. This report takes a deep dive into how health systems can best address the top challenges across all 13 key areas of the revenue cycle from patient to payments. 

A few key insights highlighted in the report to help develop a sound RCM engine throughout the patient journey include: 

  1. From 2019 to 2022, we observed national commercial payers delaying claims adjudication and appeal reviews, especially compared to pre-pandemic levels with a steady increase in days claims payable by nearly 8%. As payer restrictions return to pre-pandemic days, payers are holding up high-dollar claims requiring manual approval due to staffing shortages. Denials and DRG downgrades have also increased driving up a provider’s cost-to-collect. Choosing a partner with a global footprint is now more important than ever to stay on top of payers, guide providers to undo pricey and unfavorable contracts and proactively grow, not just defend margins.
  2. Patients expect a convenient, straightforward process that is easy and personalized. Automation and digital transformation are driving those efforts to meet patients where they want, while upskilling staff to perform higher-level functions. In today’s consumer-driven world, it is not surprising that nearly 70% of patients will choose a provider who lets them book, change or cancel appointments online. Investing in patient-centric technology, like self-scheduling tools, enables a stronger patient experience, reduces administration friction and improves financial and patient loyalty outcomes. 
  3. Providers often may not realize smaller missed revenue opportunities that add up quickly. Especially recently, constant regulatory updates like Medicaid Unwinding and the No Surprises Act are causing more revenue leakage and audit scrutiny. Top missing charges, DRG downgrades and leaving payments behind from uncompensated care pools result in revenue leakage that adds up incredibly fast. Having a safety net partner who can not only give you a larger financial parachute but also prevent these revenue cuts upstream in your revenue cycle is so important.

As an RCM industry leader with direct management of $55 billion in net patient revenue (NPR) and an additional $850 billion in NPR analyzed via our revenue performance solutions, we have a unique vantage point on and expertise in provider, payer and patient billing activities. You’ll notice in the report key trends, data insights and RCM optimization opportunities that drive both revenue generation and cost savings. We’ve utilized our own rich dataset with recommendations from our trusted experts in the revenue cycle field to provide actionable insights that help future-proof your revenue cycle.  

Those who know me know I’m always open to conversations about how we can continue to optimize and transform the revenue cycle. Shoot me an email if you have questions about the challenges your health system is facing or want to know how R1 can help you address rising costs, labor shortages, shrinking margins and any other top of mind revenue cycle challenges. I look forward to connecting. 

Author Bio: Chief Commercial Officer at R1 RCM.

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