Rejected payments top list of hospital revenue cycle challenges

Payer denials is the top revenue cycle challenge facing hospitals today, according to a study conducted by Besler and HIMSS Media.

The study surveyed 102 respondents in finance, revenue cycle, reimbursement and health information management roles in U.S. hospitals and acute care facilities.

Nearly half of respondents (49 percent) cited payer denials as the biggest revenue cycle challenge facing hospitals today. That was followed by problems obtaining reimbursement (47 percent) and prior authorization (38 percent).

Four other survey findings:

1. Respondents see clinical documentation and coding as a key area where revenue is most at risk. Forty-one percent said there is a high risk in this area, while 43 percent said there is a medium risk.

2. Most respondents said they believe revenue cycle solutions are optimized for coding and audits, but only 32 percent said they believe diagnosis-related group optimization is a solved issue.

3. Respondents cited limited budgets (49 percent), difficulty proving return on investment (48 percent) and competing projects (45 percent) as challenges to adopting solutions to improve diagnosis-related group optimization and mid-cycle revenue recognition.

4. Nearly half of respondents (47 percent) have established a revenue integrity program, with about 75 percent of those adopters reporting positive impact.


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