Rethinking Revenue Cycle Management

Revenue Cycle Management (RCM), as it exists today, is ill-equipped to handle the market forces impacting healthcare. Rapid growth in consumer payments, reduced payer reimbursement rates, an ever changing regulatory environment, and shifting consumer expectations have all contributed to the challenges facing RCM. The current approach of “bolting on” new technologies and reworking internal processes will not sufficiently address these challenges. In fact, that approach leads to greater complexities and costs to RCM processes. In response to the challenges facing RCM, the Health Information and Management Systems Society (HIMSS) has assembled a group of experts drawing from providers, payers, financial services industry, revenue cycle vendor and consultants, and healthcare associations. This group of over 60 members is the HIMSS Revenue Cycle Improvement Task Force (RCITF or Task Force).

This paper provides an overview of the work that has been done by the RCITF to date, including its vision of the consumer financial experience of the future and the impact of that vision on providers, payers, and, most importantly, consumers. The paper also includes a link to the first of a series of infographics to be produced by the Task Force. Each infographic is intended to articulate the Task Force’s vision of the patient financial experience of the future in a variety of healthcare settings. The first infographic was intentionally designed to be relatively simplistic; as the Task Force goes forward we expect future infographics to display a greater level of sophistication and detail. Each infographic will include a survey link that allows visitors to the infographic site to provide feedback to specific questions posed about the infographic. Readers of this paper are encouraged to visit the site and submit feedback. Information on how to access the infographic can be found at the end of this paper.

In addition to the work of the RCITF, we offer a brief overview of the RCM process as it exists today and the challenges it is facing from changing fiscal demands within the industry, aging technology, and, equally important, consumer expectations. Consumers are increasingly influenced by their experience with other industries such as retail, technology or mobile computing, and we are seeing this influence played out in their frustrations with current revenue cycle processes.