The COVID-19 pandemic completely disrupted the healthcare administration industry, and the effects of this disruption are still felt today. Organizations have had to face fluctuating government regulations. The ban on elective surgeries slashed budgets. Revenue cycle management teams shifted to a virtual environment practically overnight.
Healthcare organizations are now returning to a new normal, and with the year and a half in mind, leaders are beginning to rethink how they want to shape their revenue cycles. The strains of the pandemic demonstrated a need for a more streamlined, efficient revenue cycle management infrastructure, and as a result, we will see 4 major changes in 2022.
Increased attention given to clean claims
In 2020-2021, organizations witnessed a major uptick in claims denials. While this affected the healthcare industry at large, organizations without robust RCM infrastructure, such as laboratories, were especially impacted. In 2022, we expect the coding issues and claims denials will inevitably continue as providers are still sorting through the chaos of the past year.
However, hospitals, labs, and other organizations will likely designate increased attention to front-end processes to prevent denials entirely. A comprehensive approach to denials prevention “integrates case management and clinical documentation improvement (CDI) into billing and claims processes to collect key information concurrently as opposed to the uphill battle of dealing with appealing denied claims,” according to Pivot Point Consulting.
Increased automation and interoperability
Hospital systems are starting to appropriate funds for AI and RPA automation for the more front-end areas of the revenue cycle such as patient intake, registration, and coordination of benefits. They are doing this to make sure they have all necessary data, from both patient and payer, to prevent delays in the back-end of the revenue cycle.
Furthermore, interoperability between EHRs and other platforms in the revenue cycle is also helping organizations prevent claim denials by preventing duplicate patient data by providing a system alert when a patient presents with more than one set of data.
Reconsideration of workforce management
The pandemic shifted the landscape of the administrative workforce. Budgetary constraints, labor market shortages, and other factors forced organizations to put administrators in positions that required very specific expertise in payor criteria and guidelines. As organizations are beginning to develop a better understanding of the revenue cycle, they have begun to realize the necessity of having experts in the right seats to stay on top of the ever-shifting compliance guidelines for both government regulations and the major commercial insurers.
Managed services partnerships drive transformation
Instead of upending their existing systems, we predict that healthcare organizations will turn to managed services partnerships to help improve the functionalities of these systems. Hospitals and organizations looking to leverage AI, RPA, and interoperability software will turn to the experts to help them maximize their workflows and processes. For example, an organization may elect to outsource laboratory medical billing to a third party. Especially as remote work has become the new norm, it is likely that managed services partnerships will continue to supplement revenue cycle teams.
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