The past few years have been challenging for revenue cycle management (RCM), as teams adapt to pressures and changes caused by the pandemic, new laws, and changes in how healthcare staff work. There will likely be ongoing changes and challenges throughout 2023. Here are a few trends to watch.
New work models
The nature of how healthcare is delivered is changing. Some changes, such as remote work and increased use of telehealth, were due to the pandemic and the need to alter the way medical professionals provided their services. Others, such as value-based care, are due to the consumerization of healthcare — patients want lower costs and better outcomes.
- Value-based care. Increasingly, healthcare facilities and providers are moving from a fee-for-service reimbursement model to a value-based one. A value-based model rewards providers for good outcomes. It can result in better healthcare and lower costs for patients.
- Remote work. During the pandemic, remote work became commonplace. Now that the public health emergency has waned, many RCM workers are asking for more remote working options, which means provider organizations must learn to deal with the changes and challenges of remote work over the long term — or risk losing valuable staff.
- Telehealth. Telehealth also got a boost during the pandemic as providers and patients adjusted to a new reality, and payers struggled to figure out how to reimburse for telemedicine.
Use of technology
Technology is changing healthcare and related operations, including RCM, and this trend is not slowing down. In fact, it’s picking up speed as we head into 2023 and beyond. Technology is making life easier in many ways, but with the benefits come challenges as it also introduces additional risks.
- Automation. Technology has facilitated the automation of certain repetitive or manual tasks, including following up on claim denials and automating coding. This all frees up RCM staff to execute more complex or strategic tasks requiring human input.
- Artificial intelligence (AI). AI is an essential tool in healthcare. It can help with recordkeeping, diagnosing, predicting outcomes, and more. Its importance will only grow going forward.
- Increasing security risks. As the use of technology in healthcare expands, so do security risks. Healthcare facilities must increase their vigilance, educate staff, and maintain a robust IT team. Ransomware is becoming an escalating problem, especially for healthcare because of the valuable patient data within.
The new year brings along some transitions from traditional ways of billing for services as well as some new rules.
- Patient-first billing. High healthcare costs, more uninsured patients, and high-deductible insurance plans means more direct patient billing. This trend not only is frustrating and costly for patients, but also poses a challenge for providers. The debt typically resulting from patient-first billing is often more difficult to recover.
- No Surprises Act. The No Surprises Act bans balance billing for emergency services provided at an out-of-network facility or scheduled services by out-of-network medical professionals at an in-network facility if the patient was not notified of their network status.
These trends are just a sampling of the healthcare changes coming or already settling in 2023. It’s important for RCM professionals to be aware of these trends and ramp up efforts to provide more training to meet the associated challenges. Amid staffing shortages throughout the healthcare sector, outsourcing your RCM to a company with the expertise to overcome these challenges will keep your organization ahead of the curve. Contact TruBridge at 877-543-3635 to see how we can help.