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Frost & Sullivan: Physicians Focus on RCM Solutions to Prepare for New Wave of Financial Challenges
Date:6/25/2013

s many physicians are expressing dissatisfaction with the status of their profession.

"Survey after survey shows physicians are frustrated with the numerous administrative hassles associated with managing a medical practice, particularly around dealing with third-party payers," commented Fabozzi.  "Reimbursement complexities are traditionally driven by the need to comply with myriad requirements of various government and commercial payers, which together account for 85 to 95 percent of physician income. Today, more than 50 percent of payments to doctors come from private insurance, and another 30 percent comes from government plans, mainly Medicare and Medicaid. Healthcare reform will bring a significant increase in the number of patients covered under Medicaid. This situation, combined with declining Medicare reimbursement and ongoing battles over the sustainable growth rate, will likely accelerate declining profit margins."

In many cases, the IT solutions currently in use in medical practices are not fully integrated with other business and clinical solutions, including EHRs.  Lack of integration leads to data and information gaps that can increase the rate of claims denials and bad debt. Stand-alone billing and practice management solutions are on the wane in the market today as medical practices move towards integrated, end-to-end systems that unite front and back office data flows, provide seamless access to clinical data from EHRs, and rationalize and streamline the entire RCM process. As physicians look to a future of declining reimbursements, increased audits, and tightened critera for meeting patient quality, safety, and outcomes metrics, most have no choice but to leverage next-generation RCM solutions to help mitigate new challenges around getting paid.

Frost & Sullivan finds the physician RCM market is primed for transformation as practices prepare for increased patient loads and new payment and delivery models. Chang
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