The COVID-19 pandemic had a profound impact on the healthcare industry, and revenue cycle management (RCM) hasn’t been immune to its lingering effects. From administrative staffing issues to revenue cycle disruptions, the pandemic created new and unprecedented obstacles for healthcare organizations looking to realize revenues.
As we move into a post-COVID world, it’s crucial for providers to understand the top RCM challenges remaining after the pandemic. Just because the public health emergency is officially over doesn’t mean things will return to normal. Recognizing and embracing RCM challenges as the new norm will put providers in a position to address financial operations for a new age of healthcare.
Staffing challenges
In the aftermath of COVID-19, healthcare providers continue to grapple with staffing issues — and it’s having significant implications for RCM. A lack of available staff means difficulty accommodating paying patients. Not only are healthcare staff in short supply but also administrative and financial professionals.
With the emergence of artificial intelligence (AI) and automation, healthcare organizations are faced with the need to adapt their processes. Integrating these advancements into existing systems often requires additional expertise, leading to a shift in job requirements and the necessity to upskill or hire new talent.
Revenue cycle disruptions
As patients struggle to get appointments, providers experience a drop in patient visits. This decrease in patient volumes impacts revenue generation and can create a financial strain for the practice.
In response to pressure to reduce costs and adapt care delivery models, providers have increasingly turned to telehealth. While telehealth offers accommodating benefits, it also presents challenges for RCM. Namely, providers must navigate the complexities of billing and reimbursement for telehealth services — an issue with plenty of obfuscation.
The post-COVID era has also brought about changes in insurance coverage and reimbursement policies. Providers must stay updated on these changes and adapt RCM processes accordingly to ensure accurate and timely reimbursement for services rendered.
Regulatory compliance
Post-COVID, providers face increased scrutiny of their billing and coding practices as a means to combat Medicare fraud and billing errors. Government agencies and payers are closely monitoring claims to identify any irregularities signaling fraudulent activity. This heightened scrutiny places added pressure on providers to have accurate and compliant billing and coding practices.
These practices must include meticulous attention to detail and adherence to coding guidelines and documentation requirements. Providers must also invest in resources — such as dedicated compliance teams, ongoing education, and technology solutions — to maintain the integrity of their revenue cycle.
Patient experience challenges
Providers face various challenges in delivering an optimal patient experience in a post-pandemic world. Patients now seek greater convenience, accessibility, and transparency in their healthcare interactions. Striking a balance requires careful planning and workflow adaptation.
Here again, telehealth is a solution — albeit one with complex RCM implications. This includes ensuring seamless billing and reimbursement processes for virtual visits, as well as enhancing the technological infrastructure to support virtual care. Meeting the rising demand for telehealth while maintaining a positive patient experience is an issue providers must address to guarantee patient satisfaction and financial viability.
The time for adaptation is now
While the post-COVID RCM challenges are significant, they also present an opportunity for innovation and transformation. By embracing new technologies, adapting to changing patient needs and preferences, and prioritizing a proactive approach to financial operations, healthcare practices can overcome these obstacles. The right strategies and a willingness to be agile and adaptable will enable providers to build a more resilient and sustainable RCM model, regardless of future challenges.
Learn more about post-COVID RCM challenges (and ways to solve them) at trubridge.com.
