The world is changing and the operations behind healthcare reimbursement is changing with it. Healthcare organizations are recovering from an unprecedented public health crisis during which entire service lines shut down so providers could focus on stopping the spread of a deadly virus.
Meanwhile, healthcare has been going through a digital revolution. The clinical shift of EMR adoption to achieve Meaningful Use compliance has trickled down to create even more complexities in the business side of healthcare. These, historically manual processes have significant impact, and now healthcare providers are laser focused on how to streamline operations and boost performance.
All of these trends—and more—are impacting providers and combined, they will create a new normal for revenue cycle management (RCM). How healthcare organizations respond to these trends is key to optimizing financial performance.
Trend #1: Move To Work From Home
While COVID-19 had an obvious and devastating impact on healthcare reimbursement with service lines shutting down, the pandemic also triggered another major change —remote work.
Like many businesses across the world, healthcare organizations sent much of their staff home to minimize the spread of COVID-19. For months, RCM team members have been working accounts remotely with the use of digital solutions that enable workers to sign in virtually.
The work-from-home trend certainly brought many challenges, including rapid implementation of digital work solutions, increased needs for security and compliance controls, and productivity concerns. But it could become the new normal for medical A/R management now that organizations have worked through the challenges.
“The extent to which providers will enable from home flexibility remains to be seen, but we know that some changes are bound to stay in place with 75 percent of health systems and large hospitals considering permanent changes to their workspaces including WFH options,” says Priti Shah, Chief Product Officer at Ontario Systems.
“As providers consider their options, I believe we will see a lot more scrutiny of due diligence to identify technology solutions that not only support the operational needs, but also ensure compliance and productivity in a work from home environment,” Shah adds.
Trend #2: Shift To Patient As Payer
Patient as the new payer continues to pick up traction and is here to stay.
“Consumers act differently than payers, and healthcare organizations have not historically paid attention to consumers buying and paying behavior,” Shah 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 shown that healthcare providers are struggling to collect patient financial responsibility in a timely manner, with patient collections taking more than a month for about 74 percent of providers. Additionally, two-thirds of providers said this delay has made patient receivables a top revenue concern for their organizations.
As a result, organizations need to implement solutions that can address patient financial responsibility and accelerate collection times.
“Any ability to gain visibility into your data and use that to drive insights about patient payment patterns will improve cash flow. 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,” Shah states.
Trend #3: Surprise Billing, Consumer Collection Laws
The COVID-19 pandemic is shining a light on surprise billing and other collection practices, prompting lawmakers to renew efforts to create surprise billing and other consumer collection legislation to protect individuals impacted by the public health and economic crisis.
For healthcare organizations, the legislation indicates a greater focus on compliance to mitigate any risks that could impact medical reimbursement.
“From a regulatory perspective, new Federal law in our not-so-distant future will change the way consumers are billed for emergency care or being treated by an out-of-network provider when within in-network facilities,” Shah predicts. “Uninsured patients will also need to be billed differently through provider-patient bill dispute resolution processes. It is also critical to ensure your debt collection partners’ practices align to new regulations, as any mistakes in billing or violation of various billing laws may hold you both responsible from a legal perspective.”
Already, healthcare organizations and their collection partners should be preparing to comply with the final Consumer Financial Protection Bureau (CFPB) rule, effective Oct. 1, 2021. The debt collections rule spells out new rules for electronic communications, which will apply to digital medical debt collection strategies.
Additionally, organizations should prepare for potential surprise billing legislation. Lawmakers have been focused on passing a law that prohibits surprise billing and creates a new pathway for providers to collect unexpected medical bills disputed by payers and patients.
Trend #4: Increased Data Security Risks
Healthcare has been a primary target for hackers and other cybercriminals. But lately, health data security incidents have been on the rise, and that, combined with new regulations around consumer collection and data security, is impacting RCM operations.
Data breaches cost healthcare $7.13 million annually, making healthcare the hardest hit sector by dollar amount, according to IBM’s latest Cost of a Data Breach report. Additionally, health data breaches averaged 329 days, the longest period across all other sectors analyzed.
Recent adoption of digital solutions and the sensitive patient and financial data used by RCM teams needs to be carefully vetted to ensure risks for cyberattacks and other vulnerabilities are minimized.
“Increased security needs will remain ongoing indefinitely as regulation evolves along with technology and cyberattack methods,” Shah says. “Protecting your organization from security breaches with properly integrated tech solutions and processes along with keeping up with these regulatory changes will be an ongoing effort.”
Trend #5: Evolution Of RCM Automation
The healthcare revenue cycle is still largely manual, especially when it comes to claims management and follow-up. But the adoption of RCM automation has been increasing as providers reap the benefits of digital, streamlined processes.
RCM automation, however, is shifting from a nice-to-have capability to a must-have for healthcare organizations facing increasingly complex payer rules and regulations, new modes of care delivery (e.g., telehealth), and a potential uptick in denials after the pandemic.
While RCM automation can help organizations address the challenges coming out of the pandemic—in addition to the trends identified earlier—the types of automated solutions organizations invest in may shift as medical reimbursement evolves.
“Historically, healthcare organizations have been able to drive automation through rules-based logic and methodologies, but these become increasingly difficult to maintain as the need for rules expand,” Shah explains. “Finding solutions with automation that is driven by intelligence, machine learning, and RPA will eliminate the manual upkeep of these rules-based methodologies, and propel productivity further, at a much faster rate.”
RCM has been shifting as organizations enter a new era in healthcare—one in which remote work, patient financial responsibility, increased compliance and security needs, and automation are par for the course.
Healthcare organizations can stay on top of this evolution while ensuring maximum revenue collection through revenue cycle technology solutions. Solutions that are scalable and intelligent can streamline and support effective claims follow-up to keep organizations running no matter the challenges.