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EHR and RCM: A Critical Relationship in Need of a Mediator

Amanda Parada
February 14, 2024

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Your electronic health records (EHR) system is critical. It provides faster access to records, facilitates communication among healthcare providers, and supports clinical decision-making. However, it wasn’t designed to handle revenue cycle processes. So why are you still relying on your EHR to manage your revenue cycle? Wouldn’t it be better to rely on a purpose-built revenue cycle management (RCM) system? For most organizations, the answer is…yes!

Less paper but more work?

EHR systems provide a digital record for health professionals to use at every step along the patient journey. With this digital record, everyone interacting with a patient has access to the same information. And that information can be updated at each interaction. EHR systems have been incredibly valuable in providing faster access to patient records and a complete view of a patient’s care. That’s what they were created to do.

Some healthcare professionals saw the advent of EHR systems as bringing about the end of paperwork and administrative tasks. The amount of paper records has indeed been reduced. However, data needs to be entered into an EHR system for it to function properly. Often, this data entry falls to the doctor.

In 2021, doctors spent an average of 15.6 hours per week on paperwork and other administrative tasks. That number jumped to 19 hours per week in 2023. Nine of those hours are spent on EHR documentation.

Records, not revenue

As health organizations became more digitally oriented, many began using their EHR system to help with revenue cycle processes. The data entered by clinical departments is critical to the revenue cycle. While the information does transition from clinic to revenue cycle departments, the workflows to manage these data points are often lacking. That’s why the marriage between EHR systems and revenue cycle processes has not been the panacea many had hoped for.

In a survey of 100 chief financial officers and revenue cycle executives, more than 60 percent of hospitals and health systems reported not realizing optimal value from their EHR systems. Many of these financial executives believe the challenges of EHR adoption equal or outweigh the revenue cycle performance benefits.

Another survey of hospital and health system chief financial officers and revenue cycle executives revealed that revenue cycle management and the integration of electronic health records continue to be problematic. Slightly less than two-thirds (62%) of those surveyed reported that EHR adoption struggles have been “equal to or outweighed” benefits specific to the provider’s revenue cycle.

For many organizations, the answer is to increase the IT budget. That same survey revealed that 69 percent of these executives predicted that their IT budgets would rise next year.

A better answer might be a purpose-built RCM solution.


Built for the revenue cycle

Hospitals and healthcare organizations should incorporate a purpose-built RCM solution that can handle the specific challenges associated with your revenue cycle. Ideally, the solution should make your workforce more productive and efficient while also improving the patient experience.

Unlike with an EHR system, a purpose-built RCM solution provides the tools to drive revenue results, including:

  • Eliminate data navigation slowdowns with aggregation of patient-, payer-, and account-level data under a single platform.
  • Accelerate the path to resolution through automation and omnichannel patient engagement.
  • Increase payer follow-up results through like-account groupings, simplified billing frequency management, and account spanning.
  • Create easily digestible visualization of performance KPIs at all levels of the organization.
  • Supervise, enable, and improve remote and in-office staff with superior workforce management and quality assurance tools.

The best RCM solutions take advantage of automation to improve business and employee efficiency by:

  • Freeing up staff for higher-yielding activities with exception-based redundant task automation through RPA and AI technologies.
  • Reducing denials and write-offs by automating prioritized, optimized presentation of accounts for follow-up.
  • Creating a seamless workflow environment through system-agnostic bi-directional integration.
  • Enabling intelligent business decision-making through root cause analysis spanning the revenue cycle continuum.

RCM solutions are also built with the patient journey in mind and include:

  • Tailored, individual patient communication methods and frequencies to foster timely self-service responses.
  • Affordability-based payment options to put the patient in control of their financial decision-making.
  • AI-driven, dynamic P2P segmentation strategies to drive the highest probability of payment.
  • Patient profiles that are enriched with alternative data to personalize the approach to financial care by creating an in-depth understanding of their financial capacity.
  • Robust contact matching and account tying, which simplifies medical debt management for patients and contact management for staff.

No more bundling

Healthcare regulations. Self-care apps. Digital payments. Workforce shortages.

These are just a few of the factors making the world of healthcare more complex than ever before. And, as the healthcare and patient landscape seems to be continually changing, your RCM system must be flexible enough to adapt to these changes.

As revenue cycle tasks continue to grow in complexity, the need for intelligent, connected workflows is more important than ever. Unfortunately, managing your revenue cycle with your EHR system isn’t practical anymore. The demands of your RCM organization require a purpose-built solution.

Bundling things together might be a great idea when it comes to insurance or your favorite fast-food restaurant, but not when it comes to your revenue cycle!

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