Revenue cycle management (RCM),

Question: After reviewing the topics in Chapter 19 on revenue cycle management (RCM), what do you think are the biggest challenges for RCM?   How do RCM functions relate to EHRs?

Answer: Given the large scope of the “megaprocess” that is revenue cycle management, it makes sense that there would be a significant number of potential challenges to the RCM. The three parts of the revenue cycle are pre-visit, visit, and post-visit, and there are tasks within the RCM that must be completed at each stage of the cycle. Some challenges to the RCM include patient access/engagement, billing/coding errors, and underpayments/no payments [2]. While the solution to every problem with revenue cycle management may not be clear, improving an organization’s EHR is a step in the right direction towards streamlining the process. 

Having a functional EHR that is optimized to the needs of the organization is essential to the smooth operation of the RCM. According to the HFMA Youtube video assigned for class, revenue integrity is an underdeveloped area in many organizations but those organizations with a revenue integrity department saw better net revenue, compliance, and coding accuracy [3]. This same video mentioned the importance of patient engagement with the EHR through the means of online scheduling, access, etc. and how this engagement improved population health and staff productivity. The more that the patient can do in the pre-visit or post-visit stages of RCM, the less time the provider has to spend going over things like medical history that could have been entered previously or following up with test results that turned out fine but could easily be accessed through an online portal rather than having to make a phone call to the patient.

References

1. Amatayakul, M. (2017). Health IT and EHRs: principles and practice. American Health Information Management Association.

2. Experian Health, “7 top healthcare revenue cycle challenges and how to overcome them”, Published April 19, 2022

3. “The Future of the Revenue Cycle”, HFMA, https://www.youtube.com/watch?v=gEpW1a6QP7s