News Feature | July 14, 2016

Adoption Low, Opportunity Large In RCM Denial Management Solution Space

Christine Kern

By Christine Kern, contributing writer

Healthcare Revenue Cycle Management Startup

Report finds the transition to value-based care and APMs will impact the market significantly.

Adoption of vendor-provided denial management solutions remains relatively low, but opportunities remain in the RCM denial management solution space, according to findings in the 2016 RCM Denial Management Essentials Brief released by HIMSS Analytics. This Brief is a study of the U.S. hospital denial management market, and Essential Briefs series are market research studies that focus on “identifying salient topics in the healthcare IT space that highlight mind share, market share, and market opportunity of specific healthcare software technologies,” according to HIMSS Analytics.

The current study found those healthcare organizations without a specific vendor solution rely upon solutions built internally or with manual processes that meet their current needs. And while the study found adoption rates remain low, respondents also indicated a high level of satisfaction with their vendor provided denial management solution and reported they would recommend the solution they use to a colleague. This data suggests there are significant benefits of automating the claims and denial management process which include identifying root causes of denials and contributing to the reduction of denial write-offs.

Data for 2016 Essentials Brief: RCM Denial Management Study comes from 64 hospital executives, clinical, financial, and operational department heads and IT personnel on their current denial management solution usage as well as future plans for denial management solution adoption.

The study examines current and planned adoption of RCM denial management solutions’ vendor market share, mind share, and market opportunity in the space; benefits of adoption, including improved reporting capabilities and the ability to set low-balance denial thresholds; and the extent to which healthcare organization still rely on in-house built solutions or manual processes for denial management.

“Given the complexities around submitting claims and the labor associated with managing denials, it came as a surprise that more organizations have not automated the denial management process through a vendor-provided solution,” explained HIMSS Analytics Director of Research, Brendan FitzGerald. ”The move to value-based care and alternative payment models will not happen overnight. Until those models are tested and implemented, healthcare organizations will continue to focus on current processes, and automating the denial management process could greatly enhance collection efforts.”