BESLER and HIMSS Media Partner to Uncover Today’s Hospital Revenue Cycle Vulnerabilities and Opportunities

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As the diagnosis-related group (DRG) payment system marks its 36th anniversary, approximately two-thirds of the nation’s hospital and acute-care facility leaders believe DRG optimization is still a problem to be solved.

“A good program goes across the entire revenue cycle, from patient registration and scheduling, to claim adjudication,” said Laura Legg, Director of Revenue Integrity Solutions, BESLER

With hospitals and acute-care facilities under increasing pressure to optimize revenue cycles, BESLER and HIMSS Media conducted a new study to identify the biggest industry challenges and potential opportunities for improvement. The study included over 100 respondents employed in leadership roles within finance, revenue cycle, reimbursement, and health information management (HIM) in U.S. hospitals and acute-care facilities.

According to the study, while most leaders believe revenue cycle solutions are optimized for inpatient coding and audits (72 percent), only one-third believe diagnosis-related group (DRG) optimization is a solved problem – a perception that is consistent across hospitals of varying types and sizes.

Respondents identified “clinical documentation and coding” as the key area of vulnerability for lost or decreased revenue – with 84% claiming this challenge is a “high” or “medium” risk.

The constant changing of the ICD-10 coding system, used by Medicare and some insurance companies to determine a set lumpsum payment for hospitals to treat specific diagnoses, makes it difficult for hospital staff to follow and comply. Poor coding integrity leads to the two top challenges hospitals face every day: insurance carrier denials (49 percent) and inaccurate reimbursements (47 percent).

The HIMSS Media research also underscores the barriers hospital leaders named in improving revenue cycle performance – with “departmental and data source silos” (51 percent), “finding qualified staff” (47 percent), and “integrating multiple revenue cycle tools” (44 percent) cited as the top three issues.

Just as the study highlights challenges, it also showcases opportunities for hospitals and acute-care facilities to overcome these hurdles and boost revenue cycles. Results show that nearly half of hospitals and acute-care facilities (47 percent) have established a revenue integrity program –with three-fourths noting positive impact on: net collections, gross revenue capture, and reduced compliance risk.

“A good program goes across the entire revenue cycle, from patient registration and scheduling, to claim adjudication,” said Laura Legg, Director of Revenue Integrity Solutions, BESLER. “The opportunity is there for hospitals to bring in the correct amount they are entitled to, and that can often be more than what the hospital has billed for.”

To learn more about the study, including real-world wins from the implementation of a comprehensive revenue integrity program, visit the BESLER website to download the full white paper: https://www.besler.com/driving-optimal-revenue-cycle-performance.

About BESLER
BESLER combines best-in-class healthcare finance expertise with proprietary technology to help hospitals improve revenue integrity. Our dedicated service team pinpoints opportunities to optimize DRGs, enhancing revenue capture while lowering compliance risks. Over the last thirty years, our revenue recovery and reimbursement solutions have delivered more than $2 billion of additional revenue to hundreds of hospitals across the United States.

Contact: Mike Passanante
Email: MPassanante@besler.com

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Tom Fogerty
BESLER
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Mike Passanante - Senior Director of Marketing & Communications
BESLER
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