Four top trends in the RCM environment

1. Outsourcing operations

Recent industry regulations like the transition to ICD-10, Meaningful Use, and the shift to value-based reimbursement are creating exponential complexity within the revenue cycle business processes of the entire provider industry. Patient payments have become 35 percent of most physician revenues, and mainstream adoption of alternative payment models have made coding and reimbursement much more complex than the classical fee-for-service revenue cycle.¹ As a result, providers are increasingly struggling with growing accounts receivable, increasing bad-debt expense, and denied claims. These challenges and obstacles will only continue to gain momentum in the next decade. As a result, the industry is already witnessing a steep growth in outsourcing of revenue cycle functions, such as coding and billing processes.

2. Making sense of data analytics

In the last five years, the industry has witnessed an increase in companies developing RCM analytics as a means to improve overall business operations and care effectiveness. However, many have struggled with how to embrace data to make it actionable within their business process workflows, as it typically leads to uprooting existing system processes – often a difficult task if something has been done a certain way for long periods of time. It’s important for providers to understand operational workflow impact and process transformation requirements, so that data analytics becomes easily actionable. Ignoring these potential operational workflow impacts can lead to new data analytics technologies failing to be adopted and leveraged to their fullest capabilities. To succeed, healthcare leaders need to ensure their data analytics implementation strategies have a focus on workflow transformation and associate training. When embedded effectively within both value-based healthcare delivery and business operations workflows, data analytics can become actionable and powerful.

3. Provider-patient facilitated financing

With the increased adoption of high-deductible insurance plans driving patients to take more ownership over their own health through financial accountability, patients are much more at risk of having medical expenses they struggle to afford. Healthcare reimbursement has moved from largely a back-office process taking place after care services are rendered, to the front office before services are rendered. Since payment has now fallen on the patient’s shoulders, it is up to providers to ensure that patient payment responsibilities have been collected at the point of service. As a result, the industry is witnessing growth of new, sophisticated patient responsibility estimation platforms, as well as provider-facilitated patient financing options. Once a patient leaves a care setting, it becomes exponentially more difficult to collect patient payments.

These platforms allow providers to understand both patient eligibility and financial responsibility prior to rendering care services, enabling them to collect payments at the point of service. In cases where a patient needs financing to cover higher out-of-pocket expenses, there are a variety of new financing models offered by RCM companies and financial institutions to help providers receive as much payment as possible up front.

4. Patient consumerization

The new era of healthcare is shifting the way patients, providers, and payers are engaging with each other. As patients are willing to take on more accountability for their health and are choosing high-deductible health insurance plans, they are also demanding an “Amazon-like” experience when it comes to shopping for healthcare and insurance. This includes price transparency and access to physician reviews and objective quality metrics. Ultimately, patients want an easy venue – often via their mobile device – to shop, compare, and make data-driven decisions about the cost and quality of the care they need or want to buy.

In addition, providers who utilize high-performing networks coupled with sophisticated digital solutions to propel patient transparency and engagement will succeed over others who are still using legacy technology. As a result, these providers will be rewarded with better patient retention, as well as gain new patients. In addition, this paves the way for a more engaged patient population, enabling organizations to achieve improved health outcomes while meeting payment obligations.

Conclusion

As the healthcare industry increases in complexity, there will continue to be an enormous amount of focus on RCM. To maintain efficiency in their revenue cycle functions, providers must focus on these key trends and consider their options for their environment. By outsourcing revenue cycle operations, making data analytics meaningful, facilitating provider-patient financing, and adapting to patient consumerism, providers can drive efficiency to protect their overall bottom line, all while remaining competitive in the marketplace and ensuring regulatory compliance.

Reference:

1. http://www.availity.com/big-changes-to-patient-collection-practices-for-providers/