6 revenue cycle predictions for 2019

Traditionally, hospitals centered their revenue cycle management strategies on commercial and government payers. As more patients began enrolling in health plans with high out-of-pocket costs, hospitals started shifting their focus to make billing and payment processes more patient friendly. In 2019, hospitals will continue their efforts to improve the patient financial experience.   

Here are six predictions from vendors and hospital leaders on healthcare RCM.

Andrew Woughter. Senior Vice President of Product Strategy at nThrive, a revenue cycle management company

On artificial intelligence: Next year, we will see thought leaders in RCM take big steps to leverage artificial intelligence to enhance the capability of their analytical resources to make sense of their big data. The most forward-thinking will also explore the use of robotic process automation to free up human labor from repetitive transactional RCM processes. These investments in AI and RPA will become synergistic; identifying the right work at the right time as well as the right resource, human or machine to do that work. Revenue cycle leaders who are not satisfied with current performance limitations and constantly looking for improvement will take bold steps to augment the performance of their teams with new technology. We will look back at this upcoming year and see the foundational work that will ultimately lead to a truly data-driven highly autonomous revenue cycle. This disruption will allow us to free up resources to improve the human interaction with patients and put customer service at the forefront of healthcare revenue cycle management.

Cathy Bukowski. Vice President of Revenue Cycle at Tufts Medical Center (Boston)

On consumerism: As we've seen in the last couple years, consumerism is still playing a big role. I've seen articles in Becker's and in other industry publications about out-of-pocket spending increasing again for 2019. As our patients become more savvy with the internet and online tools, their communication expectations from us increase. At the same time, we're going to be met with a challenge [requirement from CMS] to publish our full charge description master. I'm not sure whether price transparency through the CDM is going to help our consumers or create bigger confusion. I think many organizations are going to have to direct the patients to phone our financial teams and work through pricing options instead of trying to understand pricing through the full CDM. I do see the beginning of calendar 2019 being a very confusing one for consumers.

On attracting talent: In this age of consumerism, the dynamics of how we operate as hospitals, physician practices, and as general healthcare providers does need to change. In the past, the front line, patient-facing positions — the people who need to engage the most with our patients and where the patients come to for their questions — have generally been entry level positions. I see that elevating and the industry taking that elevation seriously in 2019. We have to attract, train and keep appropriate talent that can manage our patients and their increasing needs.

On denial management:  I anticipate denials increasing [at hospitals] and actual write-offs increasing from the insurance companies. As we've seen, denial rates actually have come down over the last couple years; I think we're going to see those increase again as payers and providers are fighting for that last [reimbursement] dollar.  

Kellye Sherbet, President of RCM Services at Aprima Medical Software

On communicating about patient financial responsibility: Any technology that will help the patient understand their financial responsibility will be important. I think that checking everyone's eligibility will be a must and then communicating with the patient about their portion of responsibility. Another trend will be that providers are more aware that patients are being notified sooner about their responsibility. I am finding that insurance companies tend to send an email or a paper explanation of benefits to patients that says they've processed the claim and they've paid it. This means that patients know what their portion is going to be, but the providers are not getting paid as quickly. I think in 2019, providers will be more aware of this and start to react more quickly to sending out information to patients indicating their responsibility. I think texts, emails or patient portals that provide information to patients about what their responsibility is will be important.

On RCM technology: I think there will be some technology changes in scrubbing claims on the front end of the revenue cycle. I think anything you as the provider or practice can do besides checking the typical name, address, such as scrubbing for current procedural terminology code or ICD-10 acknowledgement will also be important. Additionally, any kind of technology pertaining to denial management will be big next year — what denials are you the provider seeing, how quickly are you seeing those, how quickly can you correct those to get claims out the door. 

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