Www Rcm Business: With the surge in patient out-of-pocket expenses and bad debt write-offs inside medical practises, it was evident that revenue cycle management (RCM) was in a transitional stage as 2019 got underway.
Many practises started looking into healthcare technology options that provided data-driven financial performance insights in order to stay on top of the game.
It’s obvious that patients are changing as well as healthcare as we move into a new year and a new decade with 2020.
Most patients demand cost transparency and value their financial experience as highly as their medical care. Payers are more eager than ever to spend money on preventive care, which gives them some relief.
How will all of these changes, along with obstacles like escalating overhead costs and the demand for qualified workers, affect medical practises throughout the course of the upcoming year?
Here, we respond to this query by delving deeper into the six most important RCM and payments developments for 2020.
Table of Contents
Data Mining Will Become Obsolete
Healthcare technology businesses recently boasted about “big data.” However, the onus of actually obtaining useful business intelligence from big data placed primarily on healthcare organisations.
With advanced analytics technologies that use artificial intelligence (AI) to combine various data points, frequently from different systems, we are well past that in 2020 and can deliver useful insights to your PC or smartphone.
Even the most tech-savvy physician practise executives don’t have the time to sift through endless reports to determine what changes need to be made to drive positive financial and operational changes, or to determine whether the changes they implemented are producing the desired results.
In order to ensure that the insights are having the most impact on the organisation, several companies are now taking a more practical approach and providing analytics consultancy in addition to the technology.
Additionally, these consultants provide any administration with additional peace of mind by sharing their expertise of the process modifications that have worked well at other practises.
Using analytics-based benchmarking tools, a practise can simultaneously learn how it compares to its peers on a wide range of financial key performance indicators (KPI), from denials to days in A/R over 30.
Administrative employees may then be able to direct resources to those areas that require them.
Financial Clearance Is King
Practises must make every effort to collect what consumers owe, including their outstanding amounts, before care is provided because patients are responsible for a record amount of healthcare costs.
In 2020, establishing a reliable financial clearing or pre-registration process will be more important than ever.
Pre-certifications or referrals are in place; the patient is aware of their financial responsibility and is willing and able to pay for anticipated healthcare services; and the practise has added or verified all demographic, insurance, and benefit information.
This process includes all the steps a practise must take before a patient enters their office. Practises that effectively accomplish more prior to the visit will have less collections concerns later on.
Payers Will Invest in Prevention
People who have dealt with payers for a long time may recall a time when insurance providers seemed hesitant to pay for anything that wasn’t specifically related to an urgent medical necessity.
The likelihood of considering dietary counselling, telemedicine consultations, or even early breast cancer screenings as add-ons was higher.
However, payers are becoming more savvy as more studies support population health prevention strategies. A healthy population has a lower likelihood of experiencing an expensive acute event that costs $20,000 or more.
Going future, clinicians ought to promote their screenings and other preventative services to patients more.
Automation Will Shake Up Billing Departments
Technologies that may automate and streamline repetitive, manual procedures will grow increasingly alluring as practises search for more ways to save expenses.
For instance, several pending claims can be analysed by workflow automation software to determine which ones billing employees should focus on first, second, or third.
It also guarantees that your billing and collections team is concentrated on the 20% or fewer of active claims in a practice’s overall accounts receivable that need to be worked in a given day, eliminating the need for manual worklists.
Monitoring staff productivity and financial results and identifying who your top performers are and who might require extra training is another interesting advantage of workflow automation.
The need for billing specialists to manage complicated medical claims will grow concurrently. Medical practises in rural areas may need to think about possibilities like outsourcing to third-party services because they have less access to highly qualified billing and coding experts.
Patients Want Price Transparency, Flexibility and a Better Overall Experience
We all know that patients increasingly demand greater price transparency and flexibility when it comes to their healthcare. But it’s not just one of these items that actually motivates the raving social media reviews and favourable remarks; it’s the overall patient experience.
To produce an experience that is worth sharing, practises will need to do more to include patients directly. For example, practises should clearly explain benefits or assist patients in navigating financing choices for elective care before a visit.
Underpayments to Undergo Greater Scrutiny
Am I receiving the compensation I’m entitled to? Or am I being egregiously shortchange for a standard service?
These concerns, which centre on contract compliance, continue to be common across provider groups. Additionally, they waste a lot of time and energy that could be use more effectively.
Successful practises in 2020 will aim to save time by ensuring their RCM platform provides them with the data they require, such as fee schedules, patient deductibles, etc., so they can make decisions based on facts and worry less about money.
In 2020, patient care will continue to be the top emphasis for medical groups. But the secret to long-term viability is taking measures to enhance business and operations – and build stronger relationships with patients.