Hospitals and health systems in the U.S. have had to deal with rising costs, especially for labor. For example, hospital labor costs reached 56% of total revenue in early 2023, but they need to stay below 50% to make a profit. Many rural hospitals have little money saved, sometimes only enough to cover one month of expenses. This shows how important it is to improve revenue cycle processes.<\/p>\n
At the same time, patients are expected to pay more for their care because of new value-based care models. Families often spend between $8,000 and $12,000 a year on healthcare. About 41% say they have problems with medical debt. Because of money worries, 34% of patients delay or skip care. Managing insurance, contracts, prior approvals, and denied claims makes things harder for healthcare providers.<\/p>\n
The COVID-19 pandemic made telehealth more common, which brought more challenges to billing and claim handling. Hospitals also have to follow new rules such as the No Surprises Act. This law means patients must be told costs upfront and be protected from surprise bills.<\/p>\n
Because of these issues, healthcare groups are turning to technology to handle staff shortages, cut admin costs, fix billing mistakes, and keep patients satisfied.<\/p>\n
The Revenue Cycle Technology Adoption Model (RCMTAM) is a five-step framework. It helps healthcare groups check their current technology and make plans for better revenue cycle work. It was made using data and feedback from over 100 healthcare groups and more than 30,000 data points. RCMTAM is based on evidence and helps find technology gaps and ways to improve finances.<\/p>\n
The model uses a detailed online survey. It looks at current RCM practices, technology tools, and key financial numbers like clean claims rate, days to get paid, and collections at the point of service. The survey creates a custom three-year plan with benchmarks comparing the group to others in the industry.<\/p>\n
Using RCMTAM made a real difference in hospitals. For example, at the University of California San Diego, after they used the RCMTAM plan, collections at the point of service went up from 0.8% to 1.1% of net patient revenue. This brought in over $2 million more money in one year. Clean claim rates improved from 93% to 97.6%. Accounts receivable older than 90 days dropped by 21%, and denials fell by 16%.<\/p>\n
This shows the model does not just give advice, but helps improve real work. It points out problems and offers ways to fix them. RCMTAM helps healthcare groups update revenue cycle work to meet financial goals.<\/p>\n
Adrienne Moore from Banner Health said RCMTAM is the first free and full technology adoption model made for health systems. It gives a useful choice compared to expensive consulting. Curtis Watkins from CereCore said it is like HIMSS maturity models and helps guide digital changes for revenue cycle work.<\/p>\n
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