The year 2023 was when hospitals were more concerned with revenue cycle management services and making chargemasters more current in response to ever-changing policy and regulatory changes, and increasing healthcare cost. The stakes were very high as hospitals were struggling to keep their financial stability amid decreasing margins, changing demand for labor and rising costs.
The changing environment for healthcare providers led them to focus more on efforts to minimize claims denials and delays as well as to accurately record charges and ensure that billing is compliant while keeping up-to-date with modifications to the medical code, bill policies, and updates to regulatory requirements.
In addition, four crucial areas were prioritized in 2023 when health systems tried to simplify the management of healthcare costs. They are the areas that all hospitals could be aiming for in 2024:
- Chargemaster Management
- Billing and Coding Policy Changes
- Hospital Price Transparency
- Prior Authorization for Specified Services
Chargemaster Management
Based on the 2023 study by KLAS Research, and Bain & Company hospitals and health systems are placing a high priority on Revenue cycle management (RCM) for their main investment in IT because of financial issues and shrinking margins.
Based on the findings of this report health executives believe that RCM as well as other areas provide an immediate, tangible return for their investments (ROI).
Each year, healthcare providers have to tackle the challenge of re-evaluating the code and billing guidelines.
Prior to this, providers and their suppliers have had a lot of difficulty being able to accurately record charges because of new complicated regulations. This has resulted in billing mistakes, payment delays, and an uptick in denials of claims in recent years.
A properly executed RCM plan that incorporates a complete and current chargemaster, annually scheduled training for billers and coders, and up-to-date policies and procedures have the potential to boost the collection of revenue and simplify the process of submitting claims, which ultimately contributes to the financial stability.
Billing and Coding Policy Changes
In 2023, hospitals had to keep up-to-date with a number of significant changes in managing revenue. These were changes to the Centers for Medicare & Medicaid Services (CMS) decision to reverse the 340B reduction in payments in 2023’s calendar year, the introduction of new requirements for Hospital Price Transparency as well as numerous revisions to the Current Procedural Terminology (CPT(r)) and Healthcare Common Procedure Code System (HCPCS) codes.
The introduction of new guidelines for coding specific medical procedures, together with technological advancements and medical treatments, has made it imperative for healthcare providers to code their procedures correctly to ensure that they receive the correct reimbursement.
Hospital Price Transparency
Alongside other important federal regulations relating to managing revenue streams, CMS introduced new hospital price transparency regulations within the CY 2024 Outpatient Prospective Payment System (OPPS) Final Rule.
The changes will be rolled out gradually and include a range of specifications.
The new rules include the creation of a CMS-mandated template, the requirement that hospitals include an affirmation declaration as well as a reworking of the rules for releasing basic charge information as well as the addition of new elements of data.
Prior Authorization for Specified Services
CMS also released significant changes to reimbursement policies and policy revisions within the Outpatient Prospective Payment System (OPPS) final rule.
The important OPPS Final Rule’s requirements are sweeping in their impact on the management of healthcare costs as well as charge capture policies and the way the hospitals as well as their personnel work in the future, and the types of outpatient services that may require prior approval. Revenue cycle management services can help you in this regard.
Selecting the Right Revenue Cycle Management Services Is Critical
Healthcare facilities require efficient and efficient revenue cycle management services strategies by 2024 to improve the efficiency of billing and collection as well as reduce delays and errors in reimbursement. This not only improves the performance of their financials by generating more revenue; it also assists in optimizing cash flow.
Health systems that are distributing resources to the management of revenue cycles in 2024 need to be aware of some of the strategies below:
- Choose a revenue integrity system that allows easy access to the most current pricing and codes that conform to federal billing and regulatory guidelines.
- Work with a proactive technology supplier who communicates in a transparent manner about the latest developments and changes to policies impacting revenue cycle management, as well as the best practices for ensuring compliance with the new rules.
- The goal is to streamline revenue cycle data and cost management procedures to allow providers to function at the top of their licensure to provide high-quality patient care.
Through the use of innovative technology and securing the right partners, hospitals’ billing departments are able to operate in a more open manner, more strategic pricing, and constant accurate billing.
This means that hospitals and healthcare providers can ensure financial stability by ensuring more precise reimbursement, enhanced efficiency in operations, and vigilance compliance with regulations. It’s the right time to contact revenue cycle management services.
