HFMA Co-Develops Revenue Cycle Management Technology Adoption Model

Nov. 30, 2023
Model is designed to help health systems leverage industry benchmarks to assess their current state of revenue cycle management technology maturity

The Healthcare Financial Management Association (HFMA) is working with a healthcare revenue cycle management software company called FinThrive Inc. on a five-stage Revenue Cycle Management Technology Adoption Model (RCMTAM).

The model is designed to help health systems leverage industry benchmarks to assess their current state of RCM technology maturity and build best-practice plans to optimize revenue cycle outcomes.

According to the nonprofit HFMA, health systems increasingly signal a need to modernize their RCM technology stacks, initiating enterprise projects that favor vendor consolidation, automation and artificial intelligence and platform approaches. Nearly two-thirds of recently surveyed healthcare finance leaders expressed their intention to evolve to an RCM platform in the next two years. Until now, there has been no comprehensive resource to help healthcare leaders align their progressive strategies to relevant industry benchmarks and best practices.

"Our initial analysis of more than 30,000 individual data points shows the majority (42 percent) of health systems are at Stage 1," said Hemant Goel, CEO of FinThrive, in a statement. "This affirmed our hypothesis that although many health systems know they need to transform and automate their revenue cycles, they haven't had a blueprint to guide them. Through collaboration with HFMA and health system early adopters, we are eager to contribute valuable insights that empower revenue cycle leaders on their path to financial excellence in healthcare."

HFMA said its collaboration in the design of the model empowers financial leaders to make informed decisions rooted in financial outcomes within RCM digital transformation. Key features of the RCMTAM include:

• Industry Benchmarks. The model sets technology adoption benchmarks for RCM leaders within the healthcare sector, providing a basis for organizations to assess progress against newly introduced industry standards.


• Correlation with Financial Outcomes. The adoption model leverages HFMA-defined MAP Key definitions to capture financial performance during the assessment and benchmark variance compared to the upper stages of the RCMTAM.


• Personalized Organizational Roadmap. HFMA says RCMTAM presents a clear and customizable adoption roadmap that enables all healthcare organizations, regardless of their current RCM vendor landscape, to tailor digital transformation strategies to their unique needs and objectives.

"In a departure from conventional models, this approach prioritizes the deliberate implementation of technology within healthcare organizations. Positive change in healthcare demands innovative solutions," said Richard Gundling, senior vice president at HFMA, in a statement. "We believe in the enhanced problem-solving capabilities of using maturity models, particularly RCMTAM, to guide organizations toward sustainable and effective revenue cycle management.”

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Revenue cycle management solutions company CodaMetrix has closed a $40 million Series B funding round to create AI solutions that improve medical coding quality. Founded in 2019, CodaMetrix’s CMX platform was built in partnership with Mass General Brigham to provide real-time audit capabilities and seamless EHR integration, which are used as a feedback loop to continuously improve AI learning. The software-as-a-service platform uses machine learning, deep learning, and natural language processing to continuously learn from, and act upon, the clinical evidence stored in electronic health records (EHRs). As a multi-specialty platform that classifies codes across radiology, pathology, surgery, gastroenterology, and inpatient professional coding, Boston-based CodaMetrix said it is the first platform to have an impact across departments by alleviating administrative burdens from billing staff. On average, CodaMetrix said, providers using the CodaMetrix platform experience a 60 percent reduction in coding costs, 70 percent reduction in claims denials, a 5-week acceleration in time to cash, and improvements in provider satisfaction, quality and compliance. The company has partnered with several health systems – including Mass General Brigham, University of Colorado Medicine, Mount Sinai Health System, Yale Medicine, Henry Ford Health and the University of Miami Health System. “Medical coding is one of the most time-consuming, understaffed and inherently error-prone parts of the health system revenue cycle. Hospitals face a high demand on human and financial resources and clinicians must often work through tedious, administrative processes away from patient care,” said Hamid Tabatabaie, CodaMetrix president and CEO, in a statement. “Our game-changing AI platform delivers vital automation which not only addresses these pain points but, more significantly, changes claims data from notoriously unreliable to clinically valuable. We are proud to serve leading provider organizations with a comprehensive and transformative automation solution, setting the standard for coding quality as part of our vision to change healthcare through the use of AI.” The company’s Series A funding was led by SignalFire. Frist Cressey Ventures (FCV), Martin Ventures, Yale Medicine, University of Colorado Healthcare Innovation Fund, and Mass General Brigham physician organizations also participated in the round. The Series B was led by Transformation Capital with continued support from existing investors SignalFire, Series A lead, and Frist Cressey Ventures.