The pandemic caused the hospital revenue cycle process to undergo a huge upheaval in 2020 and 2021. The long shutdown, spike in covid patients, shortage of skilled staff, remote working, and sudden, changes to payer and government rules, shift to a tele health created havoc of an unprecedented and unmanageable kind. The lessons from the two back-to-back pandemics have made providers extra cautious and now as they get prepared to step into 2022, they will be fine tuning their approach to incorporate learnings into the new approach they need to take to make healthcare revenue cycle stronger, more streamlined and nimbler. We believe that revenue cycle process is all set to witness the following transformation in 2022.
| The revenue cycle management healthcare market will see a stupendous growth– from USD 67.8 billion by 2026 from USD 40.9 billion in 2021, at a CAGR of 10.6% during the forecast period. |
Renewed Focus on Denial Mitigation
The importance of denial mitigation as a more effective tool in managing claims denial has dawned upon healthcare providers like never before. Therefore in 2022, healthcare providers will focus more on denial mitigation than ever before. This because of the significant ways in which denial patterns shifted during the pandemic. The magnitude of COVID-19 diagnoses, constant changes to diagnostic codes and sudden transition to telehealth, caused such confusion that providers and payors both struggled to comprehend and implement new requirements.
Providers now have a vast backlog of denials to sort through and the pile is growing by the day. Even today, the confusion prevails to a large extent. The possible change in coding rules due to Omicron is likely to compound matters for payors and providers alike. Providers for instance are expecting more coding and claims denials next year, payors are expecting fraudulent claims to mount.
It is because of this growing uncertainty that providers will be embracing denial mitigation programs at a break neck speed. The program will be tailored to focus on strengthening front-end processes to stop denials from happening in the first place. It aims to integrate case management and clinical documentation into the billing and claims process and scoop all the necessary information concurrently. The overarching objective is to address key pain points in collecting the right information, especially in cases with narrow checkup times, and keying it correctly in the EHR to prevent claims denial.
Accelerate Front-End Processes with Advanced Technologies
Embracing programs to reform front-end processes can be effective only if all its drawbacks are addressed properly. One such drawback is relying heavily on manual intervention. This has led to errors of different kinds, especially during the pandemic when providers have been struggling to manage patient rush. Therefore, to make the denial mitigation program truly effective, many providers will focus in automating a number of front-end areas of the revenue cycle, such as registration, eligibility verification and coordination of benefits. This will help providers capture all necessary patient and payor information up front and prevent mistakes and backend billing delays that primarily lead to denial.
Likewise, AI will help address other common issues such as duplicate patient IDs, a problem that manifested itself alarmingly during COVID-19 because of additional reporting requirements. In fact, during the pandemic, duplicate patient IDs become a major issue because of lack of integration between hospital EHRs and other systems. Automation will help providers provide a system alert to spot patient presents with more than one identification across revenue cycle departments. Unlike the past, when providers relied on siloed automation to tackle such issue, in 2022 there will be a significant uptick in integrating processes with automation. This will help them create more streamlined processes across revenue cycle departments, so that critical things that lead to denials can be done more expeditiously.
| Why Outsourcing RCM Services Will Become More Important in 2022 The following trends will lead to rise in outsourcing of healthcare RCM requirements a. Fall of claim denial appeals from private payers from 56 percent to 45 percent in the last 2 years. b. Fall in average success rate for claim denials appeals for Medicaid claims from 51 percent to 41 percent. c. Increase in denial write-offs due to medical necessity from 27 percent to 53 percent in just 2 years |
Re-orient RCM Workforce Management
The pandemic triggered a reduction in workforce availability. The revenue cycle department was no exception. In many cases, staff from the revenue cycle department had to be redeployed in new areas to deal with staff shortages. This impacted the performance of revenue cycle department especially in the face of constantly changing payor criteria. There was a spike in billing mistakes. Learning from this experience, providers will come up with an improved workforce plan to manage possible workforce crises more effectively.
Therefore, in 2022 most providers will redesign their revenue cycle process to have one expert per payor. This will help them stay in control of the expected changes from the major payors because of the mutating virus. Likewise, providers will go the whole hog to expand their regulatory compliance teams and make the process of bill review more meticulous and make claims submission properly scrutinized.
Yet another trend that is expected to get a massive boost in 2022, is outsourcing revenue cycle process to expert vendors. The two big reasons for this are to deal effectively with sudden skill shortages and ensure seamless scalability in the face of rising workloads. Over the years, and particularly during the pandemic, third-party vendors have proved their efficiency in supporting hospitals in different capacities and across different difficult situations.
Rely More on Managed Service Partners
As healthcare organizations go the whole hog in embracing advanced technologies, they will tie up with experienced partners to support them with the expertise and tools needed to keep them on tract. As investing on these technologies will involve huge costs, providers will leverage proprietary AI, RPA and analytics-based tools across the revenue cycle to tech enable frond-end processes. As they lack the capabilities to design, implement and maintain these technologies, they will seek bank om managed services partnership to make the most of all the technologies. Yet another reason to enter into such partnerships is to support work from home requirements in the event of another devastating outbreak. The first outbreak served as eye opener for healthcare organizations, and they are more open to idea of work from home tasks than before and will have it ready as a back-up option. Besides the above-mentioned reasons managed services will also be required to handle data center management or the critical task of maintenance and upgrades 24×7. All these will make strategic partnership a key success differentiator in 2022.
Who We Are and What Makes Us an Expert?
MedBilling Experts is a healthcare BPO service provider that specializes in revenue cycle pro services. We have a long history of partnering with hospitals and clinics to simplify their revenue cycle process and make it more accountable. Our complete range of hospital revenue cycle management services includes medical billing, medical coding, claims denial management and payment posting. We bank on timely, seamless and up-to-date communications to assist you stay ahead of competition. If your healthcare business is looking to get full control of your RCM process talk to us now.
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