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Analyst: Big changes ahead for revenue cycle management systems


New RCM systems will improve small practices’ ability to manage claim denials, improve reimbursements and boost their business operations.

Revenue cycle management (RCM) systems will continuing to expand fairly rapidly in the small physician practice market, said Aaron Gleave, research director at health IT review firm KLAS Research.

Gleave also predicts that integration of systems associated with patient payments will continue, and vendors will develop unified RCM platforms that incorporate new tools designed to improve patient engagement, analytics and population health management. 

He noted that small medical practices are often ill-equipped to handle a variety of issues such as the rapid growth of patient payments, changes in the regulatory environment and inefficiencies in account management such as denials of claims.

“The challenge for vendors who are offering RCM solutions is for them to be able to keep up with those changing needs in a way that satisfies small practices’ ability to maximize revenues,” Gleave told Medical Economics.

KLAS estimates that while 66% of small practices of fewer than 10 physicians think it’s worth investing in RCM technology, 33% said ploughing money into an RCM system isn’t worth the money. Of the 33% that refuse to buy new RCM systems, Gleave said many practices seek help with their RCM operations by joining an independent physician association (IPA) or decide to handle the claims and billing side of their business on their own.

“For a small practice, especially if we are talking about one, two or three physicians, it's very much a leap of faith to put the business piece of your practice in the hands of someone else and outsource it,” Gleave said.

However, while some practices are hesitant to purchase RCM software, Gleave said many small practice physicians are ready to embrace the technology especially since many younger doctors, who have recently graduated from medical school are familiar with electronic health records and other clinical and financial systems. Additionally, small practices must keep up with the changes that impact payment systems.

“The needs of smaller practices have evolved. They are pressing across the entire spectrum, on the billing side, the practice management side, population health and patient outreach and engagement,” Gleave said.

Next: 3 reasons for a single vendor solution


Gleave said that there are three key reasons why small practices would benefit from a single vendor solution.

1.The benefit of a fully integrated solution. Small practices that use a unified system built from the ground up on the same platform and using the same coding has its advantages. Primarily, physicians have the ability to transfer data seamlessly between the electronic health record, billing and claims management systems which will help small practices improve functionality and provide greater usability of the technology.

2.One vendor is better than two or more. Going to one vendor with a practice’s problems helps solve that problem more efficiently than using multiple vendors. It eliminates confusion and finger pointing, and helps small practices build a better relationship with their vendor.

3. Vendors are offering more tools. By building RCM platforms with ancillary modules such as patient outreach, patient engagement and population health tools as well as analytics software, physicians can plan ahead and make better business decisions that strengthen their ability to collect revenues. These features are becoming increasingly important to revenue cycle management systems.

As single RCM systems become more popular in the small practice market, Gleave said vendors will have to offer greater transparency to physicians by letting them know their technology roadmap. Additionally, small practice physicians will need greater vendor guidance on issues that help the practice through specific technological challenges, such as tracking claims denials and resubmissions.



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