Revenue Cycle Trends for 2022 and the future
Several factors such as the dawn of the digital revolution, rise of telehealth, shift to work from home models, surprise billing regulations, AI-enabled processing, the rise of rogue nation-states leading to increasing cybersecurity risks, and patients now being responsible for increasing portion of payments are some of the key trends that impact healthcare providers. How healthcare providers respond to these trends is key to optimizing their financial performance.
In this paper, we take a deeper look at the factors that will shape the revenue cycle business in 2022, and years after.
#1: Telehealth is now a $250 billion opportunity.
With a growth of over 38x in COVID, Telehealth is here to stay. The Center for Medicare and Medicaid Services (CMS) expanded the 2021 physician fee schedule to include telehealth codes for many services. Leaders managing the revenue cycle function must watch these trends closely as the regulatory guidelines on telehealth evolve rapidly.
#2: The future of healthcare is in the home.
With as many as 75 million people belonging to the Baby Boomers category (born between 1946 and 1964), which is around 30% of the US population, the future of healthcare is in the home. Private duty nursing, non-clinical care, companionship services are all part of the HCBS ecosystem. As healthcare providers integrate home and community-based services into the care delivery continuum, revenue cycle leaders and managers will need to adapt to the changes it brings to their revenue cycle.
#3: Rise of mental and behavioral health clinics.
Per Mental Health America, in 2019, just before the COVID-19 pandemic, over 19% of adults, i.e., an estimated 50 million Americans, experienced a mental illness. As many as 4.5% of them had severe thoughts of suicide. As many as 15% of youth have experienced a major depressive episode. We are also seeing a rise in specialized SaaS (software-as-a-service) based revenue cycle platforms focused on mental and behavioral health. In the future, we believe that the revenue cycle for behavioral and mental health facilities will require focused software and experienced, specialized RCM professionals.
#4: Medicaid wellness rules and the emergence of wellness chains.
Practices and healthcare institutions must now verify and document information about the work hours and health habits of Medicaid patients when filing claims. Healthcare providers must train their denial management and collections staff on the new Medicaid guidelines.
#5: Wearable devices – providing information; empowering healthcare providers.
As care shifts to the home, wearables will become part of a connected care ecosystem pushing physiological data real-time, providing valuable insights on patients, and aiding the ability of doctors to provide accurate diagnostics and care.
#6: Rising consumerism.
Rising consumerism in healthcare has many implications in the way care is delivered. Issues such as price transparency, no surprise billing, digital health, branded care delivery systems, and more, get interwoven into this megatrend. Revenue cycle leaders must redesign their revenue cycle around the consumer i.e. the patient and support them by providing patient-friendly billing, electronic statements, flexible payment plans, and more.
#7: Move to work from home and investments in productivity tools.
Revenue Cycle Leaders and Managers must consider investments in workflow automation and productivity measurement tools for their staff to improve enterprise productivity.
#8: The revenue cycle is going digital - AI, RPA, and machine learning.
AI is getting inside the RCM hood, well gradually. But that is changing, and changing fast. Service providers like Access Healthcare have improved payer portal adoption, automated payment posting, and automated status to shift staff to denial management. Automation is now taking the shape of
SaaS-based platforms can provide anytime, anywhere access.
#9: The increasing relevance of Analytics.
The insights gleaned from predictive analytics will help eliminate errors, identify root causes, automate revenue cycle workflow flow, identify training needs of staff and clinicians, and reduce denials. With reports ranging from revenue cycle KPIs to the operational performance of team members, predictive analytics can improve the effectiveness of the RCM team of hospitals.
#10: Labor utilization - doing more with Less.
With the labor shortage becoming more acute, you must invest in enterprise workflow and digital governance tools to improve organizational productivity. With improved workflow, workforce productivity can be tracked more effectively and drive efficiencies. An increasing number of RCM leaders are feeling the need to improve productivity with ideas such as improving agent time on the system, effective work queue design, and improved monitoring of human productivity.
#11: Increasing financial activity in the service provider landscape.
The RCM service provider landscape has seen unprecedented financial activity through the last few years. PE investments, M&A, IPO filings, strategic engagements between healthcare entities and RCM services providers - you name it, the industry has seen all strategies in good measure.
We see significant consolidation in both onshore and offshore service provider space, with premium valuations being given to tech-enabled plays.
#12: Survival of the fittest – tech-enabled RCM service providers to thrive.
Leaders of the pack will be those organizations that can deliver differentiated automation platform pricing along with a holistic solution encompassing technologies to solve real-world issues in the front-end, mid-cycle, and back-end revenue cycle.
Access Healthcare chose a divergent path to build echo, the industry's first robotic process automation platform developed by revenue cycle practitioners.
#13: Providers to expand outsourcing coverage.
With demonstrated success in RCM functions, service providers are now shifting the focus to care delivery support services such as CDI, Virtual scribing, and Virtual Nursing.
It is a very challenging time to be in healthcare with multiple headwinds such as declining reimbursements, COVID-19, and labor shortages threatening the financial survival of healthcare entities. We believe the answers lie in process rigor, technology, and creative strategies to improve patient experience and care delivery while improving revenue and reducing costs to collect. We hope that you benefit from the trends we have provided in this paper and can shape your strategy,