What You Should Know:
– New Chilmark Research report on revenue integrity in healthcare reveals a transitional market making strides to address the new burdens of modern care economics.
– The ongoing COVID-19 public health emergency underscores the imperative need for automation and reduced administrative costs even clearer.
Revenue cycle has and continues to be one of the most difficult challenges in healthcare. These issues manifest in the claims process of submission, appeal, and remittance, but the causes are found much earlier in clinical workflows. Rather than think of these as separate issues, they should all be considered under a broader category of revenue integrity. The latest report from Chilmark Research, Revenue Integrity in Healthcare: Solutions Driving Payment Performance, reveals a market in flux as new technologies are applied to old problems, increasingly complicated by contracts that include performance and reporting requirements.
Modern Revenue Integrity Solutions Can Improve Financial Performance
New software and platforms can accelerate, automate, and improve the accuracy of these activities. Automated outreach, demographic and eligibility checking, computer-assisted coding, natural-language processing, and more traditional revenue cycle platforms.
These tools are offered by:
– Electronic Health Records (EHRs)
– Independent Platforms
– Best-of-Breed Solutions from outside the Revenue Integrity space, but with powerful tools to address payment needs
These activities are essential for healthcare enterprises of all sizes, scopes, and specialties. They are needed whether the organization is primarily concerned with fee-for-service (FFS) reimbursement or value-based care (VBC). The ongoing COVID-19 public health emergency has made the need for automation and reduced administrative costs even clearer. With appointment volumes dropping, provider organizations are faced with the need for reliable, accurate payments for their care activities more than ever. These solutions are equally valuable for traditional provider care and for modern virtual care solutions like telehealth.
“Accounting and revenue cycle work can never fix these issues. They need to be addressed where they occur and prevented from showing up in revenue cycle in the first place. One mistake in patient registration that was easy to fix can cause millions in complicated denials down the road.”– Lead Analyst Alex Lennox-Miller
Each type of solution (EHR, Platform, Best of Breed) is evaluated based on how they address the needs of provider enterprises. The report reviews the current state of the market, the maturity of solutions, and the strengths and weaknesses of each solution type. While the current market is valued at more than $20 billion, projections within the report show its expected growth to nearly $35 billion in the next five years. The report shows which segments of this market can expect annual growth rates exceeding 10% and which will slow to under 2.5%.
Profile of Leading Revenue Integrity Vendors
In addition to the categorical analyses, this report includes 13 profiles of major and promising vendors: 3M, Allscripts, athenahealth, Cerner, Change Healthcare, Hayes|MDAudit, Medicomp Systems, Optum, PatientMatters, RevSpring, Sift, and ZOLL. Each profile includes an assessment of the vendor’s strengths and challenges, detailed descriptions and evaluations of the product capabilities and market execution, and rankings across 24 categories.
Managers and directors of healthcare organizations looking for ways to address revenue cycle issues, lower clean claims rates, or improve strategic revenue projections will appreciate the report’s clear breakdown of vendor offerings and the impacts on their clinical and non-clinical staff. Payers, including self-insured employers, and other organizations interested in the total cost of care will find the market overview and product evaluations of great value, helping them understand the tools and challenges their partner organizations will be using.