You can be excused for believing that the healthcare industry has been rolling in profits during the past few years. In actuality, many healthcare providers confronted the highest threat to their survival during COVID-19.
To begin, the pandemic relentlessly overwhelmed hospitals and boosted hospitalizations that threatened to shackle the healthcare services industry. Many providers cut salaries and let go staff. Now, they are looking for payments from a patient base that’s mentally and financially worn-out.
It’s not surprising, then, that COVID-19 performed as both an instrument and an accelerant in pushing important trends in healthcare RCM. What we now have is an assortment of regulatory changes, growing patient-as-payer responsibilities, a full-fledged dependence on automation and incredible cultural shifts that put employees in their homes.
That said, the healthcare industry is forever evolving, and it can be tough to keep up with the most recent RCM developments. Below, some of the emerging trends around healthcare RCM to watch.
Trends in Revenue Cycle Management
The Use of Robotic Process Automation, Artificial Intelligence and Machine Learning
Some of the more noticeable emerging trends in RCM are both the efficacy of robotic process automation (RPA), artificial intelligence (AI) and machine learning. These innovative technologies are being employed more and more to help streamline the medical billing process and increase efficiency. For example, AI can routinely recognize mistakes in claims so they can be amended before they’re submitted.
Remote Working
While COVID-19 affected medical care repayment with service lines being done away with, the pandemic similarly instigated another meaningful change – remote work. In the same way as numerous other organizations across the globe, healthcare providers sent quite a bit of their staff home to reduce the spread of COVID.
For quite some time, RCM associates have been working from a distance with the help of forward-thinking solutions that allow workers to sign in from a distance. The work-from-home tendency created a slew of difficulties, including quick execution of computerized work arrangements, and increased requirements for security and consistency controls. Yet, it could still grow to be the new norm for clinical A/R management since healthcare providers have experience dealing with the difficulties.
The Shift to Patient as Payer
Patient as the new payer continues to pick up traction and appears here to stay.
“Consumers act differently than payers, and healthcare organizations have not historically paid attention to consumers buying and paying behavior,” says one healthcare observer. He explains, “It is not simply about streamlining an operational process. It is about understanding who is likely to pay and the best time and mode of communication to engage that consumer to ensure payment takes place.”
In fact, research has demonstrated that healthcare providers are struggling as patient collections are taking more than a month for approximately 74 percent of providers. Moreover, two-thirds of providers report that this deferment has made patient receivables an uppermost revenue issue for their organizations.
As a result, organizations need to put into practice solutions that can tackle patient financial responsibilities and boost collection times.
“Any ability to gain visibility into your data and use that to drive insights about patient payment patterns will improve cash flow,” continues our healthcare observer. “Identifying methodology for your patient population to pay their self-pay balances in a way that matches their consumer tendencies will not only improve cash flow but impact your patient satisfaction ratings as well.”
Payment Changes for Practice and Patient
Managing payment changes is a huge topic in RCM. Payment plans and the move to credit card on file are both at the foreground in RCM trends.
According to the Kaiser Family Foundation, half of U.S. adults postponed or simply missed health or dental care in the past year due to expense. Practices can recover money little by little if a patient has the means to pay over a period of time, and patients receive the care they need.
The shift to credit card on file has made it stress-free than ever for patients, particularly repeated patients, to pay faster. It offers the patient and provider more time as practices get paid quicker and replace obsolete payment collection and appointment scheduling workflows.
A Boost in Data Security Risks
Healthcare has been a principal focus for hackers and other cybercriminals. But recently, health data security occurrences have been on the increase, and that, along with new guidelines for consumer collection and data security, is affecting RCM.
According to the popular IBM Cost of a Data Breach Report, there is an average of $10.1 million for each particular breach in the healthcare market, exceeding every other
industry sector. In reality, the report goes on to describe that this cost is the highest breach cost for the last 12 years. Moreover, such breaches in the healthcare industry are in the region of nearly 330 days, surpassing the average of all sectors that were analyzed.
Recent implementation of digital solutions and the confidential patient and financial data employed by RCM groups must be cautiously investigated to make sure risks for cyberattacks and other weaknesses are reduced.
Dealing with Medical Bills
There have been noteworthy legislative and regulatory adjustments over the last several years, too. The No Surprises Act went into effect last year, for example, shielding patients from surprise medical bills created from out-of-network emergency care. The law also compels insurers and providers to negotiate payments in final-order arbitration, in which the various parties provide a payment sum, and an independent mediator selects one or the other.
This law is certain to have a major effect on healthcare RCM as providers will have to pinpoint out-of-network claims early on and designate codes to these claims within their digital records. They’ll also need to speed up the explanation of benefits, assemble the right claims in sync with one another and process them appropriately with internal departments or outside vendors.
Medwave Helps Solve RCM Challenges
The management team at Medwave is committed to providing trained, knowledgeable professionals who understand the complicated healthcare payments infrastructure, as well as the industry’s increasingly complex regulations and compliance standards.
Give us a call today to find out what we can do to help solve your revenue cycle management challenges. You’ll be glad that you did.
