The most significant mid-cycle revenue cycle challenges stem from fragmentation, according to a report from the Healthcare Financial Management Association and Akasa.
Incomplete and inaccurate documentation remains the most frequently cited challenge, but many leaders said the real breakdown occurred in the handoff between documentation and coding, according to the Dec. 17 report. Even when documentation is complete, gaps in coding accuracy can create the same downstream problems of denials, delays in patient billing and quality score variances.
The report said many of these inefficiencies stem from disconnected systems and siloed teams.
“Even large, sophisticated organizations operate with layers of legacy technology that don’t easily communicate — forcing manual reconciliation across departments and systems,” the report said. “The result is a revenue cycle weighed down by friction rather than a lack of insight or intent.”
The report surveyed 519 healthcare finance leaders, including CFOs, vice presidents and directors of revenue cycle and HIM at hospitals and health systems across the U.S. The report was commissioned by revenue cycle automation company Akasa and conducted through HFMA’s Pulse Survey program between April 15 and April 26.
Pain points differed somewhat based on the size of the organization. Smaller hospitals were more likely to cite staffing and denials among their biggest mid-cycle challenges, while larger systems pointed to technology limitations.
Here is what leaders said were their most significant mid-cycle pain points:
- Incomplete and inaccurate documentation: 28%
- Insufficient staffing: 17%
- High rate of coding denials: 11%
- Ability of current technology to meet expanding goals/needs: 8%
- DNFC and DNFB issues: 7%
- Lack of alignment between CDI and coding teams: 7%
- Insufficient quality assurance and audit processes: 5%
- Remaining compliant with coding standards: 3%
- Prioritizing cases for CDI review: 2%
- Other: 12%
Read the full report here.
