What does the Revenue Cycle Management industry need to look out for in 2023?

In 2020 and 2021, the healthcare industry was in the middle of a pandemic, unlike anything we had experienced in several decades. The only priorities then were to provide medical services to everyone who needed them and sustain, as a practice.

2022 bought some normalcy to the industry, and before we knew it, 2023 is here. Healthcare experts and revenue cycle management companies hope that 2023 will help them bounce back and start focusing on revenue generation and growth strategies instead of just worrying about staying in the market.

The following are major trends that revenue cycle management companies need to look out for in 2023.

1. Protecting revenue streams

More than calling this a trend, protecting revenue streams will become a necessity for all healthcare practices in 2023. Between 2021 and 2022, Medicare rejected 20% more claims, and the general rate of denials has increased in the last few years.

Reimbursements are the major, if not the only, revenue stream for healthcare practices dealing with patients with insurance coverage. Revenue cycle management companies need to work on handling the denials rate by changing their current RCM processes.

Every step of RCM, from documentation to coding and submissions, needs to be tweaked and made more efficient if denials have to come down.

Quintessence understands how important steady revenue generation is for our clients, and that’s why we have made dramatic changes to our processes to ensure your claims pass through successfully. Our AI and ML-based billing and coding tools bring precision and speed to your existing RCM operations.

2. Investing in RCM tech

If there is one trend that will remain for the next several years, that’s focusing on RCM tech. There was a time when technology was just assistive support for the workforce to make their jobs a teeny bit easier. Right now, though, with the growth of Artificial Intelligence, your tools can work as well, if not better, than human experts.

Investing in the right technology will be like two pairs of eyes and hands checking every claim, picking out errors, and correcting them before the claim is sent out.

When you decide to work with revenue cycle management companies like Quintessence, we first wow you with our impressive range of tools designed to make billing, coding, and auditing easier. Codessence, our coding tool, offers speed, consistency, precision, and accuracy to coding. By designing our coding tool to match your exact requirements, every single code sent out will meet compliance regulations and quality parameters.

Reimburssence is our AR workflow tool, and this is a one-stop solution to handle claims that require further follow-up. This tool quickly puts claims into suggestive baskets – helping billers know what to do with the claim. Over time, the tool improves good touches.

3. Improving patient experience

A while back, patient experience was only associated with front-end healthcare departments. In recent years, revenue cycle management companies have realized that their efforts also contribute to patient experience.

Patients are the end healthcare consumers, and when your RCM operations make their day difficult, delayed, or uncomfortable, they will not return to you.

As a result, in 2023, improving patient experience will also become an add-on responsibility of billers and coders. Here is why.
• The RCM operations start with documentation; if it is incomplete/ineffective, it will lead to delays in reimbursements and frequent follow-ups with the patient.
• Every time a patient engages with the documentation and billing team, it is an opportunity to offer a better experience. This will happen when the revenue cycle management companies invest in the right tools and make their processes and UI more user-friendly and accessible.

Experts suggest picking up online communication tools and integrating them into the existing RCM operations. For instance, you can design a system where patients can request appointments or make changes online without the need to call up or visit in person.

You can also have a setup where patients can get results, bills, and laboratory results online and share results with service providers.

4. Staying agile

This is also more of a long-standing change than a trend. Insurance providers like Medicare and Medicaid keep changing their terms and conditions regularly. This is not something new. However, things changed rapidly and uncontrollably in the last two years thanks to COVID-19.

Telehealth became a reality, and revenue cycle management companies had to update themselves to learn about telehealth allowances and coverages quickly. Now, it looks like telehealth is here to stay.

That means, as a provider, you need to be able to offer both in-person and telehealth services and bill them accordingly.
Also, right now, insurance providers are leaning towards Value-Based Care and are suggesting they want providers to move away from the traditional Fixed Fee structure. If this kicks off on a large scale, you will need to quickly make significant changes to your existing operations and process systems.

Unless you are an agile service provider, you may not be able to handle all the changes that 2023 is set to bring.

5. Focusing on Business Intelligence

If you thought the work of revenue cycle management companies was to handle billing and coding, things have changed. Companies like QBSS have started offering more comprehensive and inclusive services beyond billing and coding.

What do RCM service providers have to do with Business Intelligence? Everything!

Revenue cycle management companies that handle your RCM operations have access to a large amount of vital data that can be analyzed to find business trends and strategies to help the brand grow.

If your service provider has not been doing this, they have been wasting vital data to date. It makes sense for these RCM service providers to handle business intelligence, too, because they know the end-to-end processes at a very intimate level.

As a healthcare provider, you must analyze available data, generate reports, find trends, and work on your BI strategies if you want to grow in 2023.

Conclusion

The above are the five trends that revenue cycle management companies and healthcare providers need to be aware of for 2023. With the beginning of a new year, we hope the healthcare industry finds the space and the opportunities to offer the best services, grow as a brand, and improve its financial positioning.

If you have been looking for an RCM service partner to help achieve all this, get in touch with QBSS experts to know what differences we can bring to your existing setup.

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