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- The health care industry is consistently evolving and many organizations are challenged to keep pace
- Constant regulatory changes inhibit providers from establishing an effective revenue cycle
- There is more political and legislative focus on consumer-driven health care and transparent billing practices industry-wide
- The provider industry, in general, is expected to operate on razor-thin margins
- A growing urgency to increase bottom line revenues is forcing providers to stay competitive within the market by leveraging new, emerging technologies
- Clinical specialization and provision of diverse outpatient services has contributed to reliance of many hospitals to support charge capture activities through disparate clinical and billing systems
- A clean claim often requires effective interdepartmental coordination and communication, which is often inefficient and undervalued
- It is estimated that 80-90% of all patient bills contain errors, which are likely to lead to significant missing revenue
- Ineffective charge capture management is to blame for significant missing revenue in the outpatient setting
- The General Accounting Office estimates that fraud in health care ranges from $60 billion to $600 billion per year — or anywhere between 3% and 10% of the $2 trillion health care budget. (Healthcare Finance News October 2009: Fraud costs healthcare industry up to $600M a year)
- The government reportedly recovered nearly $700 million in improper Medicare payments through its RAC pilot program, conducted from 2005-2008.
- It is predicted that Medicare and Medicaid payments will continue to decline, thereby making it critical to capture and bill all appropriate charges.
