The Revenue Cycle Management industry has already been through a rough ride, like every other industry in this pandemic. Now that the world has established a new normal, with a mix of old and new habits, a contemporary routine has set the pace. There are some key takeaways from the time during and before the pandemic, that everyone in the industry needs adapting to, for maximizing reimbursements.
The year 2021 has seen a major inflow of existing ideas that were implemented without much delay or hesitation. The need or the pressure to keep the healthcare industry running at its personal best, has induced this transformation. Let’s see some major trends that have become very prominent today.
There is no surprise that this tops the list. AI has become very common that almost every provider, hospital and payer has implemented it in at least one scope of the Revenue Cycle, as a way to streamline the payment process. AI is the new normal and has become an ‘impending inevitable investment.
Even though the pandemic is one of the worst crisis humanity has had to go through, it had definitely accelerated the process for the healthcare industry in adapting to more accessible modes of care. Tele-health though functional was not a preferred choice for major participants in the industry. Both patients and providers were highly skeptical about it pre-pandemic as healthcare is not just a service but a very personal experience. Now with CMS prioritizing tele-health with bringing in various considerations by expanding coverage in the Physician fee schedule 2022, it stands as an incentive for providers to make a shift to tele-health as a primary form of care.
Covid-19 has showed us that there are some downfalls to the fee-for-service reimbursement method, with providers taking a hit due to the drop in volume. Major payers like Blue Cross, Blue Shield and Humana have announced a few value-based care agreements in this pandemic, showing how value-based reimbursement is the future of the Revenue Cycle.
With value-based reimbursement on the rise, the dependency on Revenue Cycle analytics is enormous. Investing in predictive analytic tools aid in the ability to determine possible revenue and can guide the Revenue Cycle process to focus on areas of inefficiency. These insights also help in understanding different payers and their payment patterns, hereby sorting out gaps in denial management.
Trying to keep up with the above trends while recouping lost revenue from the pandemic is quite a challenge, that not everyone can take a risk about. But that does not mean absorbing setbacks in business. Many providers and Revenue Cycle leaders have outsourced their RCM, thereby eliminating staffing shortages and maintaining better finance with reduced cost.
The medical billing process has evolved continuously to be able to offer the best healthcare for the country. For players in the RCM industry, adopting to such trends decides their business position and determines their survival momentum for the next decade. A classic example is the conversion to ICD-10 from ICD-9. By taking advantage of a well-established, technologically invested business partner like Quintessence, Providers and Revenue Cycle leaders have been able to experience all the benefits of the latest transformations, without the need to drain their pockets for the same.
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