Hospitals and ambulatory care groups, like other types of businesses, rely on financial systems to manage administrative and financial back-office functions. Although many of healthcare’s financial requirements are identical to mainstream business needs, others are very different due to industry regulations and the added complexity of third-party payers.

Traditionally the domain of healthcare information system (HIS) vendors, the healthcare financial system sector is now populated by both HIS vendors and best of breed financial system vendors all competing for market share. Another major change in the market is the evolution of system names and functionality in HIS and physician practice management products. Current offerings incorporate clinical applications to provide more comprehensive and more integrated systems with improved alignment between front-end clinical data collection and back-end billing functions.

Although nearly all healthcare organizations have some sort of financial system, care provider organizations continue to meet emerging challenges by replacing legacy systems or adding on specialty financial management software packages. But having a robust financial system doesn’t ensure that care delivery organizations are able to optimize billing and reimbursement.

From the Healthcare Informatics Research Series, Trends in Healthcare Financial Systems explores healthcare organizations’ strategies to ensure quality care delivery while maximizing billing and reimbursement. Using survey information gathered from senior HIT executives, the report assesses the current state of financial and revenue cycle management systems among healthcare providers. It also considers how major trends, including consumer-directed healthcare and pay-for-performance programs, are affecting financial operations.

In addition, Trends in Healthcare Financial Systems delves into the impact of increased consumer responsibility and changing reimbursement models. Other questions the report answers include:

•  What do care providers see as their single greatest challenge in streamlining reimbursements—and what are they doing about it?
• Are revenue cycle management systems living up to their promise?
• One in four organizations plans a financial system purchase or upgrade. What are they looking for?
• What are the most difficult regulatory compliance measures to meet among providers?

Trends in Healthcare Financial Systems examines how hospitals, healthcare delivery networks and ambulatory care providers feel about the upcoming transition to ICD-10 clinical coding. It also identifies market penetration for different types of financial and revenue cycle management solutions—and the vendors that provide them.

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TABLE OF CONTENTS

SECTION 1

Executive Summary

Key Points

SECTION 2

Respondent Demographics and Infrastructure Capabilities
Types of Organizations Represented
Physician Offices and Ambulatory Care Organizations
Executives and Professionals
Sharing Data Beyond the Enterprise

SECTION 3

Financial Systems Functionality
Financial Systems and Capabilities
Alignment of Care Delivery with Data Capture
Financial Systems in Use
Satisfaction with Current Financial System
Purchasing Plans
Executive/Financial Dashboards

SECTION 4

Reimbursement Issues
Percentage of Business Requiring Claims Submission
Claims Management

SECTION 5

Revenue Cycle Management
Front-End Financial System Automation
Real-Time Eligibility Identification Capabilities
Back-End Automation
Revenue Cycle Management Systems

SECTION 6

Key Issues and Trends
Donations Under Stark Exception and Safe Harbor Regulations
Consumer-Directed Healthcare
Pay-for-Performance
ICD-10 Issues

SECTION 7

The Corporate View
Products and Services
Greatest Need for Financial Systems

APPENDIX I

Greatest Challenges: Verbatim Responses

APPENDIX II

Organizations and Companies Mentioned

APPENDIX III

List of Figures

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Organizations and Companies Mentioned Organizations

Trends in Healthcare Financial Systems, Digital

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