In the past few years, revenue cycle management (RCM) has seen challenges due to the pandemic, new laws, and changes in healthcare industry. Today, the healthcare revenue cycle (RCM) landscape is going through tremendous changes. The trends are driven by the need to handle the healthcare industry’s largest challenges, such as workforce shortages, human errors, and claim denials. Advanced technologies such as block chain, big data and AI have played important roles in reshaping the RCM process. Outsourcing and patient-driven solutions have also helped in providing immediate relief from operational challenges. The aim of this article is to highlight some of the top RCM trends shaping the healthcare industry today.
Integration of AI into RCM
While other businesses are enjoying the benefits of artificial intelligence AI, the healthcare sector has not been left behind. AI has transformed and will continue to transform RCM by addressing most of its challenges. It had a variety of tools that include natural language processing which analyzes unstructured data line patient notes. It also automates tasks like the generation of financial reports and drafting denial letters. Below are some of the ways in which AI improves the RCM process.
- It handles denial management by predicting denial patterns and suggesting preventative actions to reduce denial rates.
- AI Chabots has improved patient communications by answering billing queries and explaining charges to patients on time.
- It streamlines insurance verification and preauthorization workflows to avoid denials and confusion.
- It provides autonomous medical coding to improve coding efficiency for faster medical billing processing.
AI enhances claim accuracy by eliminating errors and mistakes in claims before submission. Therefore, it allows staff to focus on essential duties rather than dealing with repetitive tasks.
Most claim denials and late payments are due to late preauthorization and eligibility verification issues. AI has become a valuable tool as it can automatically preauthorize and verify the eligibility of a patient claim. For the past few years, healthcare facilities have lost finances due to claim denials, where a patient has already received care services. Today, it is possible to know whether a patient is eligible for payment even before starting the procedure. The system conducts real-time checks to make sure that a patient is financially cleared before rendering services. Providers utilizing automation have been able to reduce claim denials and administrative burdens. Some automations solutions are:
- Robotic process automation- it automates tasks like checking insurance eligibility and submitting preauthorization requests.
- Natural language processing- it allows automated extraction of important details from unstructured clinical notes and insurance policies.
RCM Software That Drives Measurable ROI and Financial Performance
There are so many industry pressures, and investing in healthcare payment software that leads to tangible returns is vital. One of the factors that healthcare providers consider when investing in new RCM software and working with a RCM vendor is its ability to bring higher ROI. Furthermore, it is only fair for healthcare leaders to consider a new RCM platform when the current one does not show desired outcomes or bring financial gains. Research shows that low ROI is among the leading causes of why healthcare providers switch to new RCM software. For instance, those hospitals that have shifted to AI say that it has generated positive ROI. AI and advanced automation have proven to be powerful success factors in optimizing financial performance regardless of the constant shifts in the healthcare revenue cycle landscape.
Big Data and Predictive Analytics
Today, big data continues to be a game changer in hospital revenue cycle management. It is more than just numbers as its data changes to actionable intelligence that optimizes an organization’s financial performance. Predictive analytic tools identify denial patterns, allowing hospitals to reduce occurrences. With a real-time performance dashboard, healthcare facilities can track KPIs like days in accounts receivable, collection timelines, denial rates, and patient payment patterns. To stay ahead, it is imperative to implement real-time analytics to monitor essential metrics such as accounts receivables. You can also use data visualization to identify bottlenecks and enhance payment collection.
Interoperability between EHR and Other Systems
Integration has become one of the most popular trends in RCM, and EHR integration plays a crucial role in streamlining fiscal and administrative workflows. Most healthcare facilities have adopted automation driven software capable of connecting EHRs and RCM systems effortlessly. This not only allows real-time information exchange across the billing process but also optimizes revenue platforms.
One benefit of integrating EHR with RCM is leading to seamless clinical and financial data exchange, thus eliminating data silos and ensuring data stays synchronized. It also enhances compliance and reporting, ensuring healthcare providers adhere to regulations while simplifying audits. Some of the most commonly used EHRs are MEDITECH, Epic Systems, DrChrono, and Oracle Health (previously Cerner).
In conclusion, the rapidly changing RCM market has led to emerging trends that keep making it better. AI has played a great role in the changing world of RCM, allowing healthcare providers to provide real-time services. Automation is another trend that has enhanced RCM as it helps in automated preauthorization and eligibility, avoiding later financial hurdles. Organizations are also keen on investing in RCM software that brings higher ROI. Not forgetting how integration between RCM and EHR systems has made it easier to connect financial and clinical data.
Stay ahead of the curve—partner with GeBBS Healthcare Solutions to leverage cutting-edge RCM technologies, drive measurable ROI, and transform your revenue cycle for lasting financial success.
