Specialty Revenue Cycle Management Firms Revolutionize Complex Claims Processing Through Automation, Garnering Rapid Adoption Among Providers, Black Book Survey

Black Book surveyed nearly 5,000 healthcare providers in a sweeping study of the evolving revenue cycle management IT sector. EnableComp rated highest satisfaction among clients besting competitors in 12 of 18 key performance indicators.

Specialty Revenue Cycle Management Firms, formerly known as outsourced Complex Claims companies, specialize in handling the most challenging, labor-intensive, and hard-to-recover medical claims, often yielding the lowest and most unpredictable returns. Complex claims vendors refer to entities that specialize in managing and processing intricate or challenging insurance claims, typically from Workers’ Comp, VA-related, Motor Vehicle Accidents, Third-Party Liability, Denials, and Out-of-State/Region/Country claims.

Black Book surveyed nearly 5,000 financial managers from providers (including 407 hospitals, 4,188 physician practices, and 275 post-acute providers) between March 1 and April 20, 2024.

Over two-thirds of survey participants express a current pursuit for alternative methods to process complex claims internally and via outsourcing. This shift stems from concerns surrounding data security, denial rates, and accuracy, all impacting Net Patient Revenue.

In 2016, HIMSS’ Healthcare Financial News reported an expected doubling of the complex claims market, aligning with Black Book's forecast via provider polling. Despite this growth, vendor satisfaction improved primarily among only a few top-performing specialty RCM vendors. The recent Black Book financial leadership survey indicates that only 61% of existing specialty RCM clients experienced significant improvements in ROI and reductions in accounts receivable through their complex claims partnerships.

Key Survey Findings include:

Eighty-four percent of Community Hospitals (150-400 beds) currently attempting to manage complex claims internally or via an outsourcing arrangement will be moving to an alternative specialty RCM vendor as the percentage of hard-to-process claims has increased to on average to 36% of their business office’s claims workload.

IDNs and health systems currently report that 27% of their claims workload can now be classified as complex or difficult reimbursement and require specialty RCM partners to enhance their workforce.

Eighty percent of IDNs and major health systems and ninety-five percent of physician practices express either a lack of resources and/or a lack of expertise with internal processes forcing their hand at selecting a new or improved specialty RCM partner.

Ninety-one percent of post-acute providers indicated they would be engaging with a specialty RCM partner by Q1 2025.

Of the respondents presented with eighteen RCM-specific key performance indicators, 87% highlighted the primary considerations for selecting a specialty Revenue Cycle Management (RCM) partner in Q2 2024 as follows: (1) Vendor Trust, Accountability, and Reputation; (2) a robust and compliant data security system; (3) demonstrated process efficiency; (4) a track record of significant AR Reduction/ROI; (5) Innovative technology and intelligent automation tools; and (6) the vendor's expertise in multiple Claims Systems and Payer rules.

Thirty-three specialty RCM vendors focusing on complex claims reimbursement were ranked by over two thousand providers on Black Book’s proprietary key performance indicators detailed to medical providers in their 14th annual user survey for customer satisfaction, client experience, usability, and vendor loyalty.

EnableComp, based in Franklin, TN, was rated #1 in 12 of the 18 key performance indicators in Q2 2024 for Specialty RCM including best-of-breed technology and process improvement.

Among the twenty top-rated vendors also named were Waystar, Aspirion, Revecore, R1 RCM, RevClaims, FinThrive, Cognizant, Optum360, and Experian.

"Currently, providers are actively seeking assurance that they can rely on their specialty RCM partner to streamline and enhance their intricate claims reimbursement procedures, surpassing the results achieved by previous vendors or internal processes in recovering funds," said Doug Brown, President of Black Book Research. "Clients who may have experienced issues with their previous Specialty RCM partners, such as high continued denial rates, delayed payments, and unresolved or inaccurate billing, are switching to new partners that have a track record of better performance and results."

Black Book™, its founder, management, and/or staff do not own or hold any financial interest in any of the vendors covered and encompassed in this survey, and Black Book reports the results of the collected satisfaction and client experience rankings in publication and to media before vendor notification of rating results. Follow Black Book on X at http://www.x.com/blackbookpolls

For methodology, auditing, resources, comprehensive research, and ranking data, see http://blackbookmarketresearch.com

Source: Black Book Research