9 RCM Notable RCM Trends for 2021
Based on information from multiple sources, including Becker’s, Global Market Insights and others, the healthcare revenue cycle management market is growing and changing. Having a growth-enabling revenue cycle management solution in place is critical to healthcare organizations. Revenue cycle management (RCM) implies the refinement of the billing process. Of course, the word refinement is akin to the word maturation. When does it stop?
Here are 9 enlightening healthcare RCM topics worth exploring:
- The RCM market is growing:
Medical billing trends for 2021 reveals that the medical billing outsourcing market will be reaching nearly $16.9 billion.
Speaking of outsourcing, a growing number of healthcare organizations are choosing to outsource their revenue cycle business. RCM is totally separate yet requires integration to clinical operations, thus requiring in-depth knowledge and laser-focus to manage and navigate changes in healthcare revenue payment regulations, the ability to hire and train staff and implement optimal technology. Besides the operational factors, compliance problems have become challenging and risky for many organizations.
- Outsourcing is attracting smaller groups:
Smaller practices and hospitals are increasingly outsourcing RCM. The increased need for timely reimbursements and claims processing is more and more being left up to the focused experts who are most likely going at risk for payment based on net collections. The medical coding process is also becoming more complex and leads to an increased need for revenue cycle management solutions to reduce billing errors. CMS and the AMA just released new codes for areas such as COVID-19, radiology, and oncology to name three. If small groups miss codes or miscode, denials and rejections could turn into timely filing issues and missed revenue, not to mention increased cost. Neither is profitable.
- Mergers and acquisitions are on the rise:
As patient engagement increases, healthcare professionals are merging or selling to larger organizations. They include all segments from physician groups, to hospitals, to healthcare systems. This initiative enables them to provide more comprehensive medical services instantly besides gaining the scale to negotiate favorable payer contracts. When outsourcing, due to volume increases, healthcare providers can also benefit from lower rates such as billing services percentages of collections, interfaces, software subscription models and other scalable services. In addition, medical supply contracts, facility services and so on will benefit from those similar economies of scale.
- Cost management and reducing revenue leakage is critical:
With the growth in patient responsibility, comes an increase in regulatory compliance. Compliance changes can cause revenue loss due to the lack of knowledge of those issues. Organizations who outsource their RCM should expect medical billing (or coding/HIM) companies to take the responsibility for identifying and addressing revenue leakage. Experience, in-depth knowledge, a “dig deep” approach and continuous education are required to find and prevent missing revenue.
KPIs and other performance measurement benchmarks (whether outsourced or insourced) are ways to assist with the reduction of real denial rates. Partnering with excellent software, billing, clearinghouse, or other RCM companies provides a foundation for performance essential to quality revenue cycle management.
- Automation can be a game-changer:
As in most if not all industries, trends are encouraging automation in RCM operations. It is sometimes curious why companies still deploy manual processes that could be affordably replaced with automation while achieving a positive ROI. Technologies such as AI, Robotics, ETL and Rules-based procedures help eliminate redundant processes and work and also make parameter-based decisions for routing data, error correction and decision-making to streamline processes and speed work completion. Patient engagement, responsibility and focus will necessitate the increase in automation to complete more manual tasks which can’t replace direct contact. Automation of processes and software can facilitate increased patient interaction with healthcare professionals.
- Growth obstacles:
Growth inhibitors in healthcare are numerous but few if any are insurmountable. We already covered consolidation as one remedy to solving growth but there are several others. For example, few are aware that they can add the specialty of allergy testing and treatment without being an allergist or add chronic care management without any special training. Both can be accomplished using breakthrough software and time-tested procedures. Surging development in cloud computing is less expensive and installed more conveniently than in-house data center computing. The cloud-based revenue cycle management industry will reportedly exceed $80 billion by 2024. Cloud-based computing removes one more in-house obstacle to growth: over-burdened IT staffs. Three automation and outsourced operations that enable areas for growth are 1) repositioning and building new portfolio and services, 2) investing in higher level resources and 3) adopting automation and new levels of platform functionalities. Those strategies facilitate the enhancement of the value proposition through personalized services and analytics and remove growth obstacles.
- Optimizing RCM is imperative:
In manual processes one person can make a substantial difference. Whether it be a transaction or competency, the chain is only as strong as its weakest link. Any mistake in the form of coding error or incorrect entry of data pertaining to claim information, patient demographics, or other, and the overall chain is affected, thereby reducing efficiency. Many organizations are recognizing this, while others refuse to let go of what they are doing so to improve… which unfortunately for some may be the difference between surviving or becoming defunct. Optimizing the operation by whatever means available could be a necessary difference-maker. First, decisions need to be made and plans constructed to move from A to B.
- Workflow optimization is a KPI:
One of the key drivers currently augmenting the global revenue cycle management market is the growing demand by healthcare organizations to improve workflow. Workflows are a key component of error-prone, cumbersome, and costly manual operations. The overall workload experienced by the average healthcare organization has been growing at a considerable rate and is likely to continue. Hospitals and other institutions are therefore looking to RCM solutions and service providers for ways to streamline processes and help maintain accurate medical and financial records.
- Balance traditional management with newer models:
Healthcare organizations are seeking a balance between traditional operations management and a newer, more value-add approach. Their adoption rates of revenue cycle management for various purposes reflects the overall need for the market’s players to adjust and add services previously ignored to accomplish that end. For software companies it may mean providing for billing facility and professional codes on the same software platform. Other challenges will be for organizations operating in multiple countries with varying operational requirements, codes, and procedures with the ask for an RCM partner to handle everything under one roof. That will require both healthcare provider leadership and service partner leadership as well as operating models to adjust to the unfamiliar environment. Beyond the topics of technology and operating methods, leadership requirements are hefty. In essence, they require a “leader shift” to be able to adjust technology and operating models. It is no small ask and may become a trend that is the most challenging of all in the future of healthcare RCM.