The revenue cycle process and its management have continuously progressed over the last few years to keep up with the changes occurring in the healthcare industry. 2018 is no exception.
When we talk about health care units and hospitals, the primary thought that comes to one’s mind is the patient care experience as it relates to individual health and wellness. However, another valid part of this business is the seamless running of the finances, which involves the revenue cycle management and medical billing. The moment a patient schedules an appointment with you, they enter into an ecosystem of payment and processes and that journey ends when claims are filed and patient payments have been reimbursed, either from the patient or from their insurance payer.
This on the outright sounds like a simple and linear process, but it’s much more complicated. To help you organize these financial processes in 2019, most organizations in the coming year will depend on healthcare revenue cycle management experts and software systems to break down all the patient data influx.
Here are some trends to watch out for:
Payers will continue to look at ways to cut costs
Insurers have created healthcare policies, designed plans and tightened provider networks to cut down healthcare costs and they have shown success in 2018. As a professional medical billing and RCM experts, our advice is to expect payers to accelerate those programs and policies and search for more some cost-cutting techniques in 2019.
For hospitals and healthcare facilities looking for ways to improve their bottom line, many clinicians viewed imaging as a way to make up for lost dollars and elsewhere. However, experts also say that payer’s message was that medical necessity is the stronger consideration and that unit pricing needs to reflect broader market pricing.
Many providers had earlier turned this under-regulated service line into a profit center, but regulatory actions made it clear that such activities would not be acceptable.
Organizations will continue to improve denial and reimbursement settlements
Claim denials and documentation to support reimbursement appeals are the core regions where the revenue cycle management continues to struggle. Small, large, solo or Ambulatory; all are seeking innovative ways to improve the RCM processes and reduce denial rates, which is via third-party systems, or (if possible) within the host system.
Training and adoption for the new systems
As the healthcare industry transits from a legacy to a new and modern system, what it needs to consider is how to handle the change of process management for their staff. Some offices have been using modern systems for more than 10 years now. As proper training and adoption given by the employer is what propelled this successful transformation, expect the same in 2019.
Healthcare industry will rely on outside expertise in 2019
As the industry integrates into the new system and implement changes, a vital recipe for success is to contract experts in the field who understand the technical and operational characteristics of the software and the revenue management processes.
It’s very valuable to work with an experienced revenue cycle management organization that employs real consultants and people who have worked in industry and possess the know-how of the unique challenges of implementing revenue cycle solutions. We all have unique perspectives and experiences that our experts bring to the table thanks to a verified billing and coding approach.
Cost and Quality Transparency
Patients are demanding more healthcare cost data on services given. A recent Financial Patient Survey found out that 75% of healthcare consumers agree that it’s very important to know reimbursements rates before treatment.
Provider and Payer partnerships
Payers in 2018 have pushed more cost controls that are now impacting provider bottom lines, but in 2019 this partnership should not be turned one-sided. In 2018 there have been some moments when payers and providers have seen eye-to-eye. Both of them have increasingly worked collaboratively.
If you are interested in learning some more insights about our revenue cycle management and medical billing services, reach out to one of our experts here.