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Tech replaces spreadsheets and manual tasks, while engaging with patients at each stage of the revenue cycle becomes essential.
When we began 2019, it was clear that revenue cycle management (RCM) was in a transition phase, with the rise in patients’ out-of-pocket costs and bad debt write-offs within medical practices. To stay ahead of the curve, many practices began exploring healthcare technology solutions that offered data-driven financial performance insights.
As we enter the new year and a new decade with 2020, it’s clear that patients are changing, too. The vast majority of patients expect cost transparency and consider their financial experience to be as important as the care they receive. To their relief, payers are more willing than ever to invest in preventive care.
So, how will all of these developments — coupled with challenges such as rising overhead expenses, or the need for specialized staffing — influence medical practices in the next 12 months?
Here, we answer this question by taking a more in-depth look at the six most significant RCM and payments trends for 2020.
It wasn’t long ago that healthcare technology companies bragged about “big data.” Yet the burden of actually deriving meaningful business intelligence from big data mostly fell on healthcare organizations themselves. In 2020, we’re well beyond that with advanced analytics technologies that use artificial intelligence (AI) to aggregate multiple pieces of information — often from disparate systems — to bring actionable insights to your desktop or smartphone.
Additionally, some vendors realized that even the most tech-savvy physician practice executives don’t have the time to dig through endless reports to figure out what changes need to be made to drive positive financial and operational changes — or whether the changes they put into place are yielding the desired results. Now, some have taken a more hands-on approach by offering analytics consulting along with the technology to make sure the insights are making the biggest impact on the organization. These advisors also bring knowledge of the process changes that have been most effective at other practices, giving added peace of mind to any administrator.
Simultaneously, analytics-based benchmarking tools can tell a practice how it ranks compared to its peers on dozens of different financial key performance indicators (KPI), from denials to days in A/R over 30. This, in turn, can help administrative staff redirect resources to the areas that need them.
With patients responsible for a record amount of healthcare costs, practices must do everything they can to collect what patients owe, including their outstanding balances, before care is rendered. Achieving a consistent and repeatable financial clearance or pre-registration process will become more critical than ever in 2020.
This process includes all the steps a practice must take before a patient enters their office: they have added or verified all demographic, insurance and benefit information; 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. Practices that can successfully do more before the visit will have less to worry about with collections on the back end.
Those who’ve worked with payers for decades can remember a time when insurance companies seemed reluctant to cover anything that wasn’t directly tied to an acute medical need. Dietary counseling, telehealth consults or even early breast cancer screenings were more likely to be viewed as add-ons. But as more studies validate preventive approaches to population health, payers are getting smarter. A healthier population means fewer chances of having a higher-dollar acute event that costs $20,000 or more. Moving forward, providers should do more to market their preventive services, such as screenings, to patients.
As practices look for more ways to reduce costs, technologies that can automate and streamline routine, manual tasks will become more appealing. For example, workflow automation software can analyze multiple outstanding claims to figure out which ones billing staff should tackle first, second or third. This eliminates the need for manual worklists and ensures your billing and collections team is focused on the 20%, or less, of active claims in a practice’s overall accounts receivable that need to be worked in a given day.
Another exciting feature of workflow automation is the ability to monitor staff’s productivity and financial outcomes and understand who your top performers are and who might need more training.
Simultaneously, the demand for billing specialists to handle complex medical claims will rise. Medical practices in rural areas with less access to highly skilled billing and coding experts may need to consider options such as outsourcing to third-party services.
We all know patients increasingly want more price transparency and flexibility when it comes to their healthcare. But what really drives the positive comments and glowing social media reviews isn’t just one of these things, it’s the entire patient experience. Practices will need to do more to engage patients directly by clearly explaining benefits or helping patients navigate financing options for elective care before a visit, for example, to create an experience that’s share-worthy.
Am I getting paid what I’m supposed to get paid? Or am I egregiously underpaid for a routine service? These questions, centered around contract compliance, are still frequent among provider groups. And they zap a lot of energy and time that could be put to better use.
In 2020, practices that want to be successful should try to save time by ensuring their RCM platform is giving them the data they need, such as fee schedules, patient deductibles, etc., so they can make decisions based on facts and spend less time worrying about money.
As medical groups enter 2020, taking care of patients is still the most important priority. But taking steps to improve business and operations — and create better relationships with patients — is the key to long-term sustainability.
About the Author: Matt Seefeld is an executive vice president of MedEvolve, a provider of analytics, practice management and revenue cycle solutions for medical practices.Get the best insights in digital health directly to your inbox.