Providers Fight Reimbursement Challenges With RCM Solutions

By Greg Bengel, contributing writer

Declining Medicare reimbursement and ongoing battles over the sustainable growth rate accelerate declining profit margins for physicians

Of the myriad problems faced by American physicians, one of the most significant remains simply getting paid in full and on time. A recent story on wfla.com spotlights the issue, noting reimbursement challenges are “contributing to the shrinking number of independent medical practices as many physicians seek refuge under the umbrella of hospital ownership.” Despite the fact that the majority of medical practices already have IT solutions to manage billing and claims processing, the fact is, many of these solutions are woefully out-of-date.

That’s why revenue cycle management (RCM) processes are such a hot-topic these days. Providers are more aware than ever that RCM processes are of vital importance. In the midst of all the attention comes a recent report from Frost and Sullivan titled, “US Physician Revenue Cycle Management.” According to the report’s summary, “Many medical practices will need to significantly re-engineer their entire RCM function, and most seek solutions that offer robust integrations between clinical and financial systems." The report offers a guide for understanding technology applications and collection services used in the RCM market. It includes key trends in the next generation of RCM technology.

For additional insight on the plight of providers – and why the RCM market is set to explode – see the wfla.com article. The article quotes Nancy Fabozzi, author of the Frost and Sullivan analysis. “Survey after survey shows physicians are frustrated with the numerous administrative hassles associated with managing a medical practice, particularly around dealing with third-party payers,” she says. “Reimbursement complexities are traditionally driven by the need to comply with myriad requirements of various government and commercial payers, which together account for 85 to 95 percent of physician income. Today, more than 50 percent of payments to doctors come from private insurance, and another 30 percent comes from government plans, mainly Medicare and Medicaid.”

If there’s a light at the end of this tunnel, Fabozzi fails to see it. “This situation,” she says, “combined with declining Medicare reimbursement and ongoing battles over the sustainable growth rate, will likely accelerate declining profit margins.”