Healthcare has been going through a digital revolution. Healthcare organizations need to stay on top of this evolution. They can do so by keeping an eye on the latest developments and using intelligent healthcare revenue cycle management services. This will not only help to stay abreast with the trends but also ensure maximum revenue collection.
Here are five emerging trends around healthcare Revenue Cycle Management to keep an eye on in 2022:
The Use of Artificial Intelligence & Machine Learning in Healthcare Revenue Cycle Management Services
One of the prominent emerging trends in healthcare revenue cycle management services is AI and ML. The medical billing process is streamlined with the help of these technologies. For example, AI can automatically identify errors in claims and correct them before they’re submitted. This can save valuable time and money down the line.
The Shift to Value-Based Care
Value-based care is another trend gaining traction in recent years. Under this model, providers are paid based on the quality of care rather than the number of services rendered. This shift has put a greater emphasis on preventive care and population health management. As a result, healthcare revenue cycle management services have had to adapt to this new paradigm.
The Rise of Patient Financial Responsibility
With the rising cost of healthcare, patients are shouldering a more significant financial burden than ever before. This trend has led to increased patient out-of-pocket financial responsibility including deductibles, co-pays, and coinsurance. As a result, Revenue Cycle Management must now place a greater emphasis on collecting these payments from patients. Therefore, medical billing teams are focusing more on working closely with patients. It includes setting up payment plans and collecting outstanding balances during the patient visits themselves.
The Need for Greater Transparency
Due to the rising costs, patients are demanding greater transparency from their healthcare providers. They want a clear understanding of the cost of their care upfront in order to compare prices between different providers. Hence, providers must be honest about their pricing and provide patients with clear and concise bills. The bill should include a complete breakdown of all charges.
The Importance of Data Analytics
Data analytics is playing an increasingly important role in Revenue Cycle Management. Medical billing professionals can identify areas in need of improvement by analyzing data. For example, data analytics can be used to determine which claims are being denied and why. It can also track trends over time and identify potential problems down the road. This information can improve the claims submission process resulting in fewer denials and increasing the bottom line.
All of these trends are impacting providers and are creating a new normal for revenue cycle management (RCM). How healthcare organizations respond to these trends is key to optimizing financial performance.
Why you need to restructure Revenue Cycle Management to keep up with these trends
As the healthcare industry is evolving with these trends, it’s time to take a look at your practice’s Revenue Cycle Management (RCM) platform and ensure it’s still up to par with the latest RCM technology.
Healthcare technology is in the transition from the fee-for-service model (where providers are paid for every specific service rendered) to the new Value-Based Healthcare model (where providers get paid based on the quality of patient care). In the new world of value-based care, the providers have to take on accountability for an entire episode of care and where reimbursement is based on meeting high-quality measures and shared-risk of costs with patients.
Healthcare organizations with apt alignment of people, process, and technology to support and implement effective and actionable intelligence, workflow automation and patient financial clearance processes will be in the better position to maintain a sustainable financial future and maximize margin. Here are five reasons why:
RCM transforms to Value-Based Healthcare
Revenue cycle management (RCM) ensures providers with fair and full reimbursement for the care they provide to patients. The fee-for-service system is a straightforward process where medical encounters are properly documented in the electronic health record (EHR), submit claims, and follow through to payment. Now, with the Value-Based Healthcare model reimbursement is dependent on quality and cost performance. The shift to value-based care requires providers to revisit their existing RCM approaches and evolve them in four primary areas:
RCM should be optimized based on value, not just volume
Provider’s financial performance was once primarily dependent on a few top-line medical encounters such as the number of patients, and the type of services rendered. This, in turn, slowly led to the up-front accuracy of claims, and efficiency of the provider, wherein care quality was given secondary preference.
In contrast, value-based healthcare programs (including MIPS and APMs) identify quality, cost, and other output measures upon which reimbursement depends. Here are a few optimizations that help value-based healthcare reimbursement.
- Enable the accurate inputs for calculations and ensure complete and timely submissions
- Payers group benchmarks when considering the performance
- Identify those measures for which the practice is likely to over- or under-perform and creating financial scenarios based on likely outcomes
- Address the areas of under performance and find the root cause of negative outliers and drive continuous quality improvement
RCM becomes a shared responsibility
RCM management used to be a back-office function, whereas now, the providers that will thrive under Value-based healthcare will be those whose lead practice administrators are very much on the front lines alongside their clinical counterparts because they have to look together at how they’re performing against various measures. Optimizing RCM for value-based care requires a very different mindset, a different set of work culture and skills, and different supporting technology to be able to track what’s going on when patients walk out the door.
RCM should seek new analytics
Since reimbursement under value-based care is based on quality measures that practices must meet and shared-risk of costs with patients, it will become necessary for practices to acquire new technology solutions that can do the same things that payers do, to confidently assume the risk. For some practices, this might mean investing in a newer, more up-to-date EHR software designed with value-based care in mind, or at the very least to find technology that plugs-in to an existing EHR to bring it up to speed.
RCM should minimize the risks, not just denials
As value-based contracts grow, providers will anticipate and model the new risk factors that could negatively influence future practice revenue. Fee-for-service revenue cycles focused on the encounters between providers and patients that occurred between a practice’s four walls. But, value-based care models involve accountability for total episode costs, which also includes patient visits to other settings, providers, and treatments. If the provider minimizes the risks, denials would automatically would not have a scope.
Value-based care is driving the transformation of many established operations within medical groups—and the revenue cycle is no different. The tendency for some to treat RCM as a back-office function will give way to a new collaboration with clinical partners at the forefront of the practice, modeling, tracking, and designing responses to the scenarios upon which overall financial health will depend. Therefore providers need to give more weightage to measure the situation and consider outsourcing revenue cycle management to reduce spending and focus on value-based care initiatives. Selecting an outsourcing partner with the latest technology, accurate skill, and experience, binds with your specific practice and strong ongoing support will help ensure a successful implementation.
By staying up to date on the latest medical billing practices and Revenue Cycle Management strategies, you can ensure that your organization runs as efficiently as possible. If you’re looking for a medical billing solution that can help you stay ahead of the curve, you should check iPatientCare product suite. It offers a complete suite of Revenue Cycle Management services that can be tailored to meet your organization’s unique needs.
Contact us today to learn more about how we can help you improve your Revenue Cycle Management strategy.
