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Five Pivotal RCM Trends Reshaping Healthcare Beyond 2024

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Revenue Cycle Management (RCM) is undoubtedly the lifeblood of the healthcare industry, ensuring financial stability and operational efficiency. As 2024 unfolds, the RCM’s landscape is set to undergo significant transformations driven by technological advancements, policy changes, and shifting patient dynamics. These changes not only impact how healthcare providers manage their finances but also how they deliver patient care. In this article, we’ll explore five pivotal trends identified by Becker’s Hospital Review, each shaping the future of healthcare RCM. From the continued challenges in labor to the impressive strides in artificial intelligence, the evolution of prior authorization requirements, the march towards innovative payment models, and the increasing importance of patient payments – these trends offer a roadmap for healthcare providers navigating the complexities of tomorrow’s healthcare sector. These trends provide insight into the strategies and technologies that will drive the success of RCM in the years to come, ensuring that healthcare providers can continue to deliver exceptional care while maintaining financial health.

1. Continued Labor Challenges: Adapting to a Transforming Workforce

The RCM space, like many sectors in healthcare, is not immune to the challenges posed by labor shortages. Over 60% of hybrid workers in RCM are at risk of leaving, causing staffing shortages in healthcare systems. This leads to more reliance on contracted labor, which is costly and can lead to burnout and high turnover rates. This cycle puts pressure on healthcare systems financially and operationally.

Healthcare organizations are increasingly turning to offshore medical billing companies or offshore medical coding companies to manage labor challenges and financial pressures. Cloud computing advancements and improved security measures have made global resources a more appealing option. Outsourcing enables organizations to focus on their strengths and allocate more resources to areas where they excel, increasing efficiency.

Alongside outsourcing, the investment in generative AI and automation is gaining momentum. Artificial intelligence and automation demonstrate their value across RCM and clinical care.

In 2024 and beyond, automated coding, denial management, and pre-authorization are expected to be these technologies’ primary application areas. However, the introduction of these technologies isn’t without its challenges. Concerns about job security among staff and apprehensions among patients, especially concerning data privacy and quality of care, are notable. Healthcare providers must communicate that these technologies are meant to augment staff roles, not replace them. Transparency about the benefits of these technologies in improving patient care and safeguarding data is crucial to overcoming resistance and building trust.

2. Advances in Artificial Intelligence: Revolutionizing RCM Processes

Integrating Artificial Intelligence (AI) in RCM is not just a futuristic concept but a current reality; 60% of healthcare providers are actively considering investing in generative AI. In the future, AI’s role in RCM is expected to expand, especially in processes such as claims coding and pre-certification. For example, AI can be used to identify and analyze denied claims. This can help healthcare providers develop strategies for appealing these denials by recognizing common patterns in the claims. Additionally, AI can automate the process of posting payments to patient accounts. This helps to reduce the workload on RCM staff and enhances the accuracy of payments.

Another area where AI is making strides is in patient engagement. The development of AI-driven chatbots and other tools is revolutionizing how patients interact with their billing processes. This improves the patient experience and reduces the number of patient inquiries, streamlining the entire billing process.

In addition to improving patient engagement, AI is instrumental in identifying and analyzing denied claims. This capability allows providers to develop targeted strategies for appealing denials by recognizing patterns in these claims. Likewise, AI is being utilized to automate posting payments to patient accounts, significantly reducing the workload on RCM staff and improving the accuracy of payments. As AI continues to evolve, its ability to handle complex RCM tasks is undoubtedly increasing, leading to more efficient and cost-effective revenue cycle processes.

3. Prior Authorization Requirements: Embracing Efficiency through Technology

The significance of technology in streamlining prior authorization requirements is becoming more apparent, with the cost of a fully electronic transaction being less than 20% of a manual one. In 2024, payers must comply with new Medicare Advantage marketing requirements, price transparency regulations, and prior authorization policies. The final rule includes policies to streamline prior authorization requirements to reduce care delays for Medicare Advantage beneficiaries. For example, prior authorization can only be used to confirm diagnoses or medical necessity, and plans must provide a 90-day period where prior authorization is not required when a beneficiary switches to a new plan.

One of the significant changes being implemented is the final rule that aims to simplify the prior authorization process. Under this rule, prior authorization would mainly be required to verify medical necessity or confirm diagnoses. Furthermore, a new policy has been introduced, which mandates that insurance plans must provide a grace period of 90 days where no prior authorization is needed when a patient switches to a new plan. This step will help in ensuring smoother transitions for patients.

The Transparency in Coverage rule, also set to be fully implemented in 2024, requires health plans to provide transparent information about the costs patients are responsible for. This level of transparency is crucial as it helps patients make informed healthcare decisions and assists providers in streamlining their billing processes.

The shift towards electronic and transparent prior authorization processes is a significant stride towards making healthcare more accessible and efficient. These regulations are set to transform how payers, providers, and patients navigate the complexities of healthcare delivery and financing.

4. The March to New Payment Models: Embracing Value-Based Care

As Value-Based Care continues to expand its impact, RCM is establishing closer working relationships with clinical departments. This shift emphasizes the need for RCM to be more integrated with patient care, ensuring that financial processes align with clinical outcomes. Integrating AI into healthcare systems is critical in enhancing various aspects of RCM and streamlining medical billing workflows, patient registration, and claim submissions. For instance, real-time digital eligibility verification helps providers ensure the accuracy of patient information at check-in, enhancing revenue integrity.

The healthcare industry is moving slowly but surely towards value-based care payment models. According to a recent report by McKinsey, the number of patients treated under these models is expected to almost double in the next five years, with an annual growth rate of approximately 15%. This shift is part of a larger healthcare trend emphasizing value and positive patient outcomes.

The shift towards patients covering a greater share of their medical expenses has spurred a growing need for more transparent billing experiences. Financial engagement intelligence solutions are addressing this demand by offering diverse patient payment options, including implementing mobile pay. These solutions simplify the payment process and provide payment plans and flexible options, easing the financial burden on patients and simultaneously helping providers boost their revenue. By improving the patient financial experience, providers can positively impact their revenue and patient satisfaction. This focus on patient-centric financial experiences is becoming an increasingly vital component of contemporary RCM practices.

5. Increasing Value and Complexity with Patient Payments

The significance of patient payments in RCM has been escalating, particularly as a notable portion of U.S. workers, around 31% in 2020, are enrolled in High Deductible Health Plans (HDHPs). This trend is causing a shift in the RCM landscape, requiring healthcare providers to navigate more complex patient payment models. There is a rising demand for digital billing solutions and convenient payment options, reflecting the broader consumer inclination towards digital and accessible solutions seen in other industries.

Healthcare providers are adopting online payment tools to provide easy accessibility and more control to patients. Patient-friendly billing solutions that include clear cost communication, flexible payment options, and a streamlined digital experience are becoming increasingly vital. Healthcare providers can improve their financial stability and boost patient satisfaction and loyalty by focusing on these areas. This approach aligns with patients’ evolving needs and expectations in modern healthcare.

Discover the Future of RCM with GeBBS Healthcare Solutions

The five RCM trends shaping healthcare beyond 2024 represent a mix of challenges and opportunities. Healthcare providers must navigate a rapidly changing landscape, adapting to labor shortages, technological advancements, and complex payment processes. Staying ahead of these trends means embracing innovation, fostering adaptability, and continuously striving to balance operational efficiency with high-quality patient care.

As healthcare providers face the challenges and opportunities presented by the evolving RCM trends, choosing the right partner to navigate this complex landscape cannot be overstated. This is where GeBBS Healthcare Solutions, one of the largest healthcare RCM companies, steps in as an essential ally.

GeBBS Healthcare Solutions offers cutting-edge technology-enabled RCM and Risk Adjustment solutions. Their AI-integrated data analytics platform helps healthcare organizations make smarter, data-driven decisions and navigate the industry’s complexities. GeBBS’ iCode technology optimizes medical coding and auditing workflows, enhancing the overall efficiency of RCM processes.

Visit GeBBS Healthcare Solutions today to discover how they can help you improve financial outcomes while positively impacting your clients.

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