Professionals expect the market for healthcare revenue cycle management products to boom, driven in part by changes associated with measures such as the Affordable Care Act.
Before things can take off, providers and vendors must work together to address the entanglement of problems that exists in the current RCM structure.
Legacy Revenue Cycle Issues
Healthcare accounting is a bed of complex issues, compliance requirements, and seeping collection troughs. Large organizations struggle to reign in unwieldy accounts receivables; small offices often deal with issues as they attempt to manage revenue via scaled-down software originally designed for hospital environments. At every level, facilities, providers, and payers suffer from the inherent costs of RCM. According to a research analyst at Piper Jaffray, it costs up to 30 cents on the dollar to bring money from the consumer to the provider. The same process costs fractions of pennies in other industries.
Other legacy issues that challenge the viability of RCM organizations include:
- The use of a subsection of companies to manage RCM
- Systems that don’t meet the individual needs of providers or keep up with constantly evolving markets
- The process of placing risk–and, ultimately, reward–on payers instead of providers
Challenges for the Future
Providers and payers are also in the throes of a rebirth of healthcare RCM. Regardless of the outcome of the ACA, experts are betting that ideas like bundled payments, accountability, and affordability are planting their feet for the long haul, and organizations will have to shape up or ship out. Culling the dead weight in RCM is one way to ensure an organization is ready to face whatever changes may come in the next few years.
Some specific challenges may include:
- A continuing reduction in allowables as federal payers tighten belts
- Growing demands for transparency, accountability, and compliance
- Increased expenses associated with data security as records migrate to virtual spaces
Innovation, Integration, and Customization
Experts extol the virtues of processes and software that let RCM organizations innovate and customize to meet ever-changing demands. ERM and EHR software that is designed for specific niche needs, but still meet the general regulatory and data compliance requirements of the industry, will become a main stay for all offices. From DIY software that puts RCM power in small offices to enterprise-wide solutions that integrate and simplify payment structures for corporate healthcare companies, forward-thinking solutions are going to be the stars of what some are predicting will be the the next RCM boom.
Here are 5 trends the industry can expect to see in 2021
1. Data mining will be outdated
Analytic technology and its dependence on AI will combinedly bring together huge data from disparate systems. Third-party vendors will also provide insights by making offers with consulting companies and technology to ensure that hospital organizations face the greatest impacts.
2. Financial clearance prioritized
Instead of waiting for reimbursements and hounding patients for payments for services rendered, there will be a higher emphasis on achieving consistent and repeatable revenue clearance. Patients should become more aware of their ability to pay for services and practice must ensure that they collect these payments on time.
3. Insurance investments in preventive care
Studies have shown that preventive care is instrumental in keeping long-term and expensive health issues from progressing. Understandably, insurance companies are interested in paying for less expensive screening procedures rather than dolling out thousands of dollars for an individual’s lifetime. Healthier populations tend to suffer from less health complications and less procedures.
4. Automation takes over billing departments
Automated technology has been extremely useful in streamlining routine tasks that were previously performed manually. The industry can expect workflow automation software to be able to analyze multiple outstanding claims that are confusing human billers.
5. Payments face scrutiny
Healthcare professional should spend less time worrying about when and what they’re getting paid for. This can be easily maneuvered around by using a RCM platform that regularly updates with practice data.
