5 Revenue Cycle Management Trends in Healthcare

5 Revenue Cycle Management Trends in Healthcare

In the world of healthcare, revenue cycle management (RCM) is heavily influenced by trends impacting the entire market. Preparing for these is the key to surviving and thriving in the healthcare industry. To that end, this article will cover five of the biggest trends impacting healthcare revenue cycle management in 2021:

  1. The “new normal” of remote work and work from home (WFH)
  2. Changes to surprise billing and consumer collection legislation
  3. Advances in AI technology that provide actionable intuition
  4. Inconsistencies in revenue flow from more patient and upfront payments
  5. Increases to cybersecurity risks and associated compliance considerations

For each trend, we’ll also spotlight best practices to avoid risks and ensure long-term success.

#1: Work From Home as a New Normal

One lasting impact of the COVID-19 pandemic is the extent to which businesses in all industries are now increasingly open to work-from-home (WFH) solutions. There is a degree of uncertainty, however, about how well WFH will work and to what extent it will continue moving forward.

Per one report from September of 2020,1 75% of surveyed executives foresee permanent increases to WFH and remote solutions in healthcare RCM.

Maintaining Productivity as Personnel Work Remotely

Despite the challenges stemming from the uncertainty detailed above and from remote work more broadly, Harvard Business Review makes a compelling case for its potential in healthcare:2

  • Greater overall safety – HBR highlights reduced risk of infection as the most obvious safety benefit, along with less exposure to harmful radiation or dangerous machinery.
  • Capacity and resources – During the worst stretches of COVID-19, care facilities were stretched thin in terms of space and resources, which shifting online helps to mitigate.
  • Efficiency and productivity – Increases in employee morale from decreased commute times and greater comfort in their environments have greatly improved productivity.

Each of these benefits has compounding positive effects for RCM for both the payors and providers alike with workflows facilitated by remote work.

#2: Increased Security Risks Across the Board

Increases in WFH and remote revenue cycle management solutions have increased the potential risks of cybersecurity in 2021 and beyond. This is true for all industries due to the increased vulnerabilities in unsecured home networks and the general lack of oversight companies can exert over what goes on in employees’ homes. It’s especially damaging for healthcare, wherein the data cybercriminals target offers uniquely lucrative opportunities.

This last part is nothing new. Per one report,3 healthcare has suffered the highest costs per breach for the past 10 years. These costs are also on the rise, with the $7.13 million dollars estimated cost of a breach in 2020 (the cross-industry figure is $3.86 million) signifying an increase of over 10% from 2019. These figures are likely to continue rising year after year.

Negotiate the deals you deserve! Let's get started!

Cyber Security and Compliance Considerations for Healthcare

Another concern related to these risks of cybercrime for healthcare practices is the increased likelihood and cost of compliance violations. All covered entities in healthcare must follow the HIPAA Privacy, Security, and Breach Notification rules, overseen by the Department of Health and Human Services (HHS).4 These rules are now harder to follow than they’ve ever been.

Any infraction of these rules is now more burdensome, as the HHS increased penalties for noncompliance. Per Federal Register Vol. 85, No. 12, fines for individual infractions are up across the board, from the minimum for lowest-level charges ($117 to $119) to the maximum for highest-level charges ($58,490 to $59,522) and yearly caps ($1,754,698 to $1,785,651).

#3: Impactful Changes to “Surprise Billing”

Another trend likely to onset in mid to late 2021 involves new Consumer Finance Protection Bureau (CFPB) regulations on debt collection practices.6 In particular, the new rules target a practice known as “surprise billing.” In short, a surprise bill is an unexpected medical expense incurred by a patient, typically for out-of-network care undertaken in an emergency scenario.

The new regulation seeks to eliminate the practice, and it goes into effect in November of 2021.

Given the controversy around surprise billing and the long legal battle leading up to this CFPB action, a great deal of uncertainty and caution can be expected in 2021 and into the future.

How to Navigate Consumer Collection Legislation Changes

The much-maligned practice of surprise billing is unlikely to vanish completely overnight, as many instances thereof stem from gaps in communication between health care providers, payors, and patients. Still, best practices in the immediate future include but are not limited to:

  • Diversify compatibility and relationships with payors to accommodate patients
  • Maximize visibility and communication regarding in- and out-of-network rates
  • Prepare for legal inquiries and actions concerning new and existing payments

Additionally, understanding the compromising position that surprise billing can put patients in and working with all parties to increase awareness and reduce its prevalence is a win-win for all.

#4: Advances in AI and Automation Abilities

Another big change coming to RCM in 2021, which many would argue is long overdue, is a wider-scale adoption of artificial intelligence (AI). Traditionally, despite an advanced position in many other technology areas, healthcare has lagged behind other industries in finance.

Per one 2019 study,7 80% of executives surveyed indicated that 25% or less of their transactions had been automated since 2017. In addition, 30% indicated automation had no impact or a negligible impact on financial transactions. However, the tides now are turning rather quickly. In 2020, a competing study found that about 67% of providers were already using AI for RCM, while nearly 100% of those surveyed expected to incorporate it in some way within the next 3 years.8

How to Integrate Powerful Insights as Actionable Information

In particular, providers are likely to continue accelerating their adoption of machine learning and automotive abilities for financial tasks. Use cases for RCM include but are not limited to:9

  • Accessible data visualization that automatically self-populates and updates regularly
  • Highly customizable analytics dashboards automatically emphasize points of interest
  • Auto-generated insights into strengths and weaknesses, organized by client, type, etc.
  • Cross-platform navigation, integrated with sales, operational, and care-focused data
  • Centralized key performance indicators (KPI) accessible from anywhere in the system

All in all, these measures ensure those decision makers and other key stakeholders have all the information and analysis available to them to make the right predictions. They also reduce the burden on individual staff, who can then devote more time to the tasks AI cannot (yet) bear.

#5: Patient Payments and Revenue Instabilities

Another trend taking over healthcare, albeit slower, steadier than AI, is the transition to higher financial responsibilities for patients. The share of payments made by patients has been growing for years now,10 between the rising cost for medical procedures or services, gaps in coverage, and the now-defunct practice of surprise billing.

With respect to collections of accounts receivable in healthcare and RCM, dealing with patients can be challenging. The volume and diversity of parties and a general lack of infrastructure and existing relationships make it difficult to collect payments on time. Per one report,11 78% of providers cannot collect large sums within 30 days.

Best Practices for Patient Collection and Maintaining Stability

If current trends continue, providers will need to solve their patient collections problems. The best approaches for getting patients to make timely payments12 include but are not limited to:

  • Cross-training staff on best practices for direct, non-confrontational communication
  • Improving all communications with patients, but especially those on financial topics
  • Collecting payments while patients are present on-site, even immediately at check-in
  • Accepting multiple forms of payment, such as cash, checks, and all trustworthy cards
  • Leveraging any online payment platforms and technologies that your patients prefer

The sooner patients are made aware of their obligations, the sooner they’re likely to pay. And the sooner payments are made, the more likely healthcare providers are to collect in full.

Face The Future of Healthcare Revenue Cycle Management

Our expert team at PayrHealth is happy to help your company with all aspects of revenue cycle management. We’ll equip you to navigate the trends of 2021 over both the short and long terms with distinct and comprehensive solutions. 

We’ll help you sign better contracts, negotiate higher rates with new and existing strategic partners, and expand your team with the right personnel, full-time or flexible. 

To get started, contact us today!

Sources

  1. RevCycleIntelligence. Health Systems Considering Remote Revenue Cycle Management. https://revcycleintelligence.com/news/health-systems-considering-remote-revenue-cycle-management
  2. Harvard Business Review. The Case for Remote Work in Health Care. https://hbr.org/sponsored/2020/09/the-case-for-remote-work-in-health-care
  3. HealthITSecurity. IBM: Health Sector Leads in Annual Data Breach Costs, Topping $7.13M. https://healthitsecurity.com/news/ibm-health-sector-leads-in-annual-data-breach-costs-topping-7.13m
  4. HHS. HIPAA For Professionals. https://www.hhs.gov/hipaa/for-professionals/index.html
  5. OFR. Federal Register Vol. 85, No. 125. https://www.govinfo.gov/content/pkg/FR-2020-01-17/pdf/2020-00738.pdf
  6. CFPB. Debt Collection Practices (Regulation F)—Final Rule. https://files.consumerfinance.gov/f/documents/cfpb_debt-collection_final-rule_2020-12.pdf
  7. RevCycleIntelligence. Hospital Financial Automation Under 25% for Most Organizations. https://revcycleintelligence.com/news/hospital-financial-automation-under-25-for-most-organizations
  8. Change Healthcare. Poised to Transform: AI in the Revenue Cycle. https://www.ache.org/-/media/ache/about-ache/corporate-partners/change-healthcare-ai-rcm-research-study-ebook.pdf
  9. RevCycleIntelligence. Gain New Insights With Analytics, AI to Accelerate RCM Workflowhttps://revcycleintelligence.com/news/gain-new-insights-with-analytics-ai-to-accelerate-rcm-workflow
  10. RevCycleIntelligence. Patient Financial Responsibility Increased 12% from 2017 to 2018. https://revcycleintelligence.com/news/patient-financial-responsibility-increased-12-from-2017-to-2018
  11. Businesswire. InstaMed’s Tenth Annual Report Finds High Consumer Demand for Digitization in Healthcare Payments. https://www.businesswire.com/news/home/20200428005090/en/InstaMed%E2%80%99s-Tenth-Annual-Report-Finds-High-Consumer
  12. ADSC. 5 Best Practices for Collecting Patient Payments. https://www.adsc.com/blog/best-practices-for-collecting-patient-payments
  13. Qway Health. 5 RCM Trends to Influence Healthcare Industry in 2021. https://qwayhealth.com/blog/5-rcm-trends-to-influence-healthcare-industry-in-2021/
  14. RevCycleIntelligence. Top 5 Trends Impacting Healthcare Revenue Cycle Managementhttps://revcycleintelligence.com/news/top-5-trends-impacting-healthcare-revenue-cycle-management