Where Does Your Revenue Cycle Management Need to Be?

Your Revenue Cycle Management Status

Healthcare providers faced a tidal wave of challenges at the beginning of the COVID-19 pandemic, many of which endure consequences today. It’s not surprising that the revenue cycle did not evade these challenges.

The shutdown and transfer to a generally virtual care world presented substantial bedlam that the revenue cycle had never encountered in the past. Those employed in the revenue cycle moved to practically 100 percent remote working quite suddenly, billing and claims activities were turned on their head among payer and government changes. Moreover, budgets were gashed as elective surgeries came to a standstill to focus on the growing pandemic.

Revenue cycle management (RCM) is one of the most important processes in any medical provider practice. Deprived of a robust RCM procedure, practices are in danger of losing out on reimbursement and experiencing perilous decreases in revenue.

So, what’s happening in 2022 that practices need to be aware of as they relate to RCM? Let’s take a look at a few.

Revenue Cycle Management Concerns / Issues

1. RCM Automation, Merely Survive or Thrive?

   Up to now, the RCM process in many practices has remained manual for the most part. But it’s turning out to be quite apparent that RCM automation is essential to modernizing this process. With more and more intricate payer regulations, different methods of care deliverance such as telehealth, and an assortment of payers to contend with, automation will create the difference between a practice that is merely surviving and one that is thriving. What’s more, staffing shortages remain a growing challenge for providers. According to one healthcare observer, automation can help ease the pressure on collection teams. “Automation is key. Providers are being challenged to make the most of limited staff resources, especially for patient collections. It’s important to focus staff attention on the accounts most likely to pay. That means filtering out accounts that might be bankrupt or deceased and using automation for manual tasks – such a checking for charity eligibility or cleaning up patient records. Best-in-class providers are increasingly leveraging automated dialing and texting solutions to communicate with patients and help short-staffed teams focus on the tasks that matter.”

2. Work from Home Resource Issues

   As COVID-19 widened beginning in March 2020, so did various major changes in how we approached our lives. Work from home moved from being a pleasant notion to a requirement and, without warning, those working in medical billing were also doing so from their homes. True, this has been important in controlling infection and has entailed some greater job satisfaction for some, but it certainly has had its challenges. For example, when dealing with revenue cycle management with their workers, it’s essential for practices to make sure that the work solutions they’re utilizing are able to provide a high level of security and compliance controls, accompanied by techniques to help alleviate worries about productivity. Basically, practices must be sure that work performed at home doesn’t upset the billing cycle.

3. Shift to Patient as Payer

   This is something we’ve been talking about in previous articles. As high deductible health insurance plans have progressively become the standard, patients are now accountable for a bigger segment of their healthcare costs. And this isn’t expected to change any time soon. Unfortunately, for some medical practices, collecting patient payment is more difficult and often harder than submitting claims to payers. This transformation makes it a necessity for practices to settle on what might be in the way of timely payments from patients and eliminating these hitches where possible. Solutions including eStatements and ePayments can go a far in tackling these issues.

4. Increased Data Security Risks

   The healthcare field has been punched in the gut unusually hard by cybercriminals. Data breaches are not cheap, adding up to around $7.13 million annually for healthcare providers, and leading to disruptions to patient care as well. It’s critical that practices take a preemptive line of attack to cybersecurity and ease the potential of hostile events as much as possible to sidestep the would-be financial consequences from a cyber-attack.

5. Surprise Billing

   New legislation is being issued beginning in 2022 that is meant to protect patients from unexpected medical bills. Surprise billing occurs when a patient unexpectedly receives care from a provider that is not in the patient’s healthcare plan network. This can happen for both emergency and non-emergency services. For example, if a patient is having imaging performed at an in-network hospital, the radiologist might well be out-of- network, consistent with the member’s plan. If not barred by state law, the out-of-network provider can bill the patient for the variance between the billed charges and the amount paid by their insurance plan. This type of billing is known as “balance billing” and is banned by Medicare and Medicaid. The No Surprises Act will offer this similar protection to employer-sponsored and commercial health plans. The only exception for which a provider can bill more than the cost-sharing amount is if the patient receives out-of-network non-emergency services with advance notice that the service is out of network and consents to that service with a higher bill. This is, if nothing else, something to be aware of as a potential roadblock to receiving expected reimbursement.

Revenue Cycle Management is Essential

RCM is one of the most essential processes within a medical practice and it’s critical to stay atop of the trends that can offer both challenges and opportunities in the coming year. After the unprecedented few years of the pandemic, we’re seeing that some changes are still on the horizon and some holdovers from the past two years may well be here to stay, such as further automation. To be sure you’re ready for it all, you can make sure to look into partnering with a strong third-party billing company to help meet these RCM challenges and take advantage of any of these opportunities.

Contact us for a free RCM analysis.