Some of the themes that will drive revenue cycle market momentum in 2023 and beyond are technology, investments, efficiency, patient experience, underpayment recovery, and coding automation. We are seeing a new wave of consolidation, invention, and innovation at the tail end of a long period of adversity due to COVID-19 and an already challenging economic environment for hospitals, healthcare systems, and medical billing services providers. 

 

TIGHTENING PROFIT MARGINS – A PANDEMIC RAVAGED REVENUE CYCLE TO END. 

With hospitals operating front office service on razor-thin margins, forecasting cash flow and maximizing revenue cycle efficiency is more important than ever. As revenue cycle leaders and managers strive to improve business outcomes, this will drive key technology and process innovation.

Now, consider the overall trends in each of the major revenue cycle processes.

 

Patient Availability and Experience 

Patient experience is now one of the most pressing issues confronting the healthcare industry. There is a significant information gap in the area of patient payments.

Patients wonder, “How much should I pay out of pocket?” Surprisingly, finding an answer has proven difficult. Patients must have quick and easy access to information about the services provided and the associated charges, as well as the amount expected to be paid by their insurance company and the out-of-pocket expenses they are expected to bear.

It is critical to include the No Surprises Act aspect, which complicates the situation for both back office service providers and patients.

We anticipate that new technologies that can project the costs that patients must bear, improved omnichannel information availability and improved payment will improve patient access and experience.

 

Prior Authorization and Verification of Eligibility 

While there is an excellent technology for information exchange like credentialing services, prior authorization, and eligibility verification technology adoption has lagged due to a lack of standardized documentation and information exchange protocols. There is new hope for API-driven information exchanges as clearinghouses modernize.

 

Coding on Your Own

Automation technology is becoming more popular, and there is a widespread belief that automation will solve coding, billing, and accounts receivable issues. Technologies such as artificial intelligence, machine learning, and robotic process automation hold great promise for lowering labor costs.

With improved standardization through ICD-11 and a better combination of virtual scribing, Universal Medical Language Systems (UMLS), OCR, and natural language processing, medical coding are becoming data-driven and autonomous (NLP).

While it is still early days, coding technology has yet to prove effective in detecting discharges that are not fully coded (DNFC) and halting revenue leakage.

 

A/R Management, Denial Management, and Appeals Filing 

Accounts Receivable (A/R) status has moved to portals from calls. Chatbots that use conversational artificial intelligence (AI) are becoming more relevant in A/R and denial management filing. Data structures can now also be used to power customized appeals filing.

 

Working Remotely

COVID-19 mandated that revenue cycle team members use work-from-home models. It also required operations managers to be adaptable and to implement new technologies to track revenue cycle performance. We anticipate that hospitals and healthcare systems will view remote working as the new normal and encourage a significant proportion of their workforce to do so.

 

Conclusion

There has never been a better time to be in healthcare – but these are also the most difficult times. This year will force you to think innovatively, build new delivery frameworks, and create the revenue cycle of the future.

whether you are a healthcare system, revenue cycle services provider, or technology solutions provider.