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Future of Healthcare Revenue Cycle Management

The Future of Healthcare Revenue Cycle Management | 2022 Industry Trends

At the onset of the pandemic, health systems and hospital revenue cycle management faced a raft of changes. Many of which still has repercussions today. The closure and transition to a primarily virtual care environment have created significant disruptions and situations that revenue cycle management has never encountered before.

 Nearly 100% of the workforce in the revenue cycle is teleworking. Including coding and claims processes are being reversed in government and driving change. Moreover, budgets are being cut as elective surgery is halted in response to the escalating COVID-19 crisis.

How is the future of RCM Healthcare determined?

Now, as hospitals return to business, financial, revenue cycle and IT leaders are reimagining a stronger, leaner, and smarter revenue cycle. The revenue cycle is changing dramatically. Some of these changes are new, but most of them have been around for years. The healthcare industry is in a state of uncertainty as too much or too little may change shortly. We keep hearing speculation from politicians and CEOs, which makes it hard to dismiss everything. It’s important to understand that almost any change in healthcare affects the industry’s revenue cycle in some way. We’ve cut through all the noise and here’s our list of the biggest revenue cycle trends that are changing everything.

Here are 4 key points to consider when planning the future of your medical billing company and its RCM Trends in 2022:

Leap managing rejection to mitigating rejection. 

Denial patterns have changed in unexpected ways during the pandemic due to the rise in COVID-19 diagnoses, ICD-10 approved diagnostic codes and the transition to telehealth. The changes have caused massive confusion as governments and corporate payers scramble to identify new requirements, laws, and regulations. During this period of uncertainty, claims against providers and payers are experiencing increasing coding and clinical deprivation, from which providers are still trying to recover.

Service providers now have a massive backlog of rejections to sort through. They can expect to see more coding rejections and claims in the next year of the COVID-19 timeline, based on everything from misdiagnosed to missing codes and fraudulent behavior, however, there are some silver linings. We are seeing vendor organizations pause and transition to a rejection mitigation program during these challenges. That also focuses on enhancing front-end processes to prevent rejections from happening in the first place.

A comprehensive denial prevention program that integrates case management and clinical documentation improvement (CDI) into billing and claims processes to gather critical information simultaneously. Rather than fighting an uphill battle to process denial claim appeals. 

Denial prevention software can address key pain points such as shorter hospital LOS and physician office visit times. As there is a narrow window to collect the right information and document it properly in the EHR to avoid claims denials.

Fast-track front-end operations using AI and other technologies. 

The pandemic has also prompted hospitals to create smarter revenue cycle departments and processes. So they look at IT budgets and revenue cycles and ask their teams to find ways to get work done faster while increasing interoperability. Many hospitals are starting to make room in their budgets for artificial intelligence and robotic process automation (RPA). Especially automating more front-end areas of the revenue cycle, including admissions and benefits coordination.

Their goal is to obtain all necessary patient information and advance payments to prevent late billing and errors that can lead to denials. Hospitals are also using AI to address the problem of duplicate patient IDs. Additionally, it has expanded during COVID-19 due to the need for additional reporting. Duplicate patient IDs are common due to a lack of interoperability between hospital electronic health records and other technology systems.

AI is mitigating this problem which spans the entire revenue cycle, affecting everything from patient eligibility to billing. Plus the collections by providing system alerts when patients submit multiple identifications.

Hospitals have used AI intermittently to address this issue in the past. But we expect its use to increase significantly in the future. But with growing concerns about patient privacy in a post-pandemic world, organizations will need to tread carefully.

Reassess workforce management.

Efforts to reduce hospital workforces during the pandemic have forced revenue cycle teams to redeploy existing staff to new areas. One consequence of this shift is that there is no suitable expertise to master complex and ever-changing payment standards. Organizations are learning from this experience to delve deeper into 2021 with new workforce plans. 

As hospitals move forward and develop a better understanding of payment methods and payment integrity within the health system. However, they want to make sure they have the right people in the right places, including staff who specialize in specific payers.

The aim is to equip each drive with a revenue cycle expert to stay ahead of the dramatic shifts in major creditors. Additionally, we would like to see revenue cycle teams bring regulatory compliance expertise. So to keep up with changing government regulations and collaborate to advance the digital environment.

Managed service partnerships are driving transformation.

As organizations launch transformation programs, experienced partners can provide insights and tools to help them stay on track and on time. For example, hospitals aim to leverage existing AI, RPA, and analytics software throughout the revenue cycle, rather than purchasing new technology.

 However, they don’t always fully understand their functions and how to apply them. A managed services partner can help create a plan for how to get the most out of artificial intelligence and other technologies. Additionally, some revenue cycle leaders have been pleasantly surprised. When they find that their remote workforce has been productive and doing well from home during the pandemic. 

As they adjust to the long-term impact of COVID-19, many organizations maintain these remote work arrangements. Also, begin leveraging managed services partnerships to complement revenue cycle teams and deliver the best talent in the industry. However, healthcare organizations are overcoming the disruption caused by the pandemic. Plus, using important lessons learned to move toward a new future.

 As revenue cycle teams begin the transformation process, they will leverage workforce, technology, and strategic partnerships to drive new successes.

Final Thoughts 

As a conclusion, we must say that the healthcare RCM trends in 2022 are changing globally. Technology-based use will have an ongoing impact on the success of the revenue cycle. There are also significant ongoing concerns about the level of self-checkout. If we are to continue to see a downward trend in self-checkout returns.

 Additionally,  there are also a significant number of organizations that have yet to use revenue. Also, integrity management, although those organizations that claim to have a revenue integrity department say there are cognitive impacts of implementing such a department.

An organizational structure that includes clinical adaptation in the revenue cycle management. One of the effects of unpaid and out-of-pocket care on providers that we’re seeing today is definitely that people are concerned about it. 

However, there’s a lot of anxiety in the market about what’s going to happen. This change in the healthcare organization continues to change. Plus, there is still an issue that most CEOs may have us very concerned about how they manage their out-of-pocket performance. Also, how best to break down their out-of-pocket fees to track operations more efficiently.

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