You could be forgiven for thinking that the industry of healthcare has been raking in profits for the past two years. However, a lot of healthcare facilities and providers were facing the biggest danger to their existence ever during Covid-19.
The pandemic seriously impacted hospitals and increased hospitalizations were threatening to stifle the healthcare sector. Many hospitals cut wages and were forced to lay off employees. Now, they’re trying to get payments from a patient base that is mentally and financially diminished.
It’s not surprising that COVID-19 has functioned as an agent and catalyst in driving major developments in the field of healthcare revenue cycle management. What we observe is a mix of changes to the regulatory environment, growing costs for patients as payers, a growing dependence on automation, and massive shifts in the culture of employees who have them at their homes.
Healthcare providers need to implement an array of solutions based on experienced agents, data-driven analysis, and top-quality customer service that can effectively tackle coming challenges and take advantage of the opportunities that lie ahead.
More Self-Paying Patients
Patients are increasingly opting for high-deductible health plans (HDHPs) that have low monthly costs but have deductibles that are high. Patients either pay for their healthcare completely or partly through HDHP memberships, which both put more of the burden on collection.
The pandemic exacerbated the problem, leading to thousands of individuals losing their jobs as well as their health insurance coverage or both.
Employers also cut off health insurance plans for employees after it became apparent that they were shut down for a long time and forced patients to pay the costs of healthcare on their own.
Improved early-out services, such as contacting patients soon upon discharge in order to inform them of the distinction between responsibility for the patient and that of the insurer is proven to dramatically decrease the number of accounts that are subject to collections.
However, that type of investigation requires more resources, which includes specialized training and knowledge that a majority of providers do not have or are unable to do on their own.
Where Automation Doesn’t Help
The complexities of Covid-19 have also forced providers to automatize their workflows to increase efficiency and reduce expenses.
They are automating more parts of their revenue cycle which is why 78% of health organizations have automated RCM.
Yet, processes such as follow-up communication and claims management are largely manual due to the issues associated with the execution of procedures that require coordination among multi-party systems that are continually being modified by their internal teams.
The advancements in automation inside RCM will continue in the future. However, the main challenges will remain:
- Fragmentation in the U.S. healthcare system.
* New risk arrangements are rapidly replacing fee-for-service models.
A growing variety in RCM Software for claims.
Due to these reasons human involvement will be crucial to ensure that service providers are paid and paid in a timely fashion.
Effective coordination with payers regarding rejected or misdirected claims as well as quick interaction with clients to obtain their claims or organize the cost of their out-of-pocket expenses will continue to require special companies that specialize in managing complicated healthcare contact center functions.
Dealing With Bills
There have been significant changes in the laws and regulations in the past two years, as well. The No Surprises Act went into effect on January 1st, 2022, for instance, safeguarding patients from the sting of medical bills resulting from out-of-network (OON) emergency services.
Also, the law requires insurance companies and providers to make the amount of payments in a final offer arbitration, which is where each side offers an amount for payment that an independent arbitrator picks one or the other.
The law will impact the entire healthcare revenue cycle management since providers will be required to spot OON claims earlier and allocate codes for these claims in their electronic documents.
They’ll also need to speed up an explanation of benefits (EOB) as well as to group the appropriate claims together and deal with them according to the internal departments or external vendors.
Pitfalls And Opportunities Ahead
There aren’t new, large healthcare revenue cycle management companies taking on all these issues in a holistic manner. This creates the door to competitive advantages for business process outsourcing companies (BPOs) who make investments in efficient implementation software as well as the most appropriate digital tools for managing systems.
Healthcare professionals will appreciate those companies that can manage numerous implementations, integrate various systems, and implement processes that are based on RCM processes.
Data analytics is a vital tool. Also, however, most healthcare facilities don’t have these capabilities within their own facilities. Providers who offer data analytics for the past, including accounts receivables, claims, and denial management procedures, as well as other services, can help healthcare organizations better use their resources, time, and budget. Data analytics can help boost efficiency across all processes and services.
However, what many vendors might not be aware of is that well-trained customer service personnel and the continuity of their agents could prove to be more important than ever before.
