5 Trends to Watch in Healthcare Revenue Cycle Management

While a number of trends related to healthcare revenue cycle management warrant attention, almost all of them share a common source: the shift from fee-for-service to value-based care. Several variables contribute to the change, including federal regulations and fines, as well as patients choosing higher deductible health insurance plans. The movement will only accelerate as the Quality Payment Program and other measures take effect in 2017.

Fortunately, healthcare providers have taken note of the change in direction. They increasingly seek technologies and processes that help them better manage finances and improve outcomes, both their own and those of patients.

1. Technology Investments

It might seem odd to cite technology as a trend. Most businesses and organizations boarded the “digital transformation” wagon a few years ago. However, healthcare entities have oftentimes encountered a greater number of obstacles when it comes to embracing digital tools.

Switching from paper records to electronic ones simply can’t happen overnight. In addition, many healthcare organizations face outdated infrastructures that require extensive overhauls prior to launching digital solutions.

A survey from ReportsnReports finds that the global revenue cycle management (RCM) market should reach $7 billion by 2020 due to increased investments in healthcare IT and provider consolidation. RCM solutions accelerate revenue cycles by streamlining processes and increasing “follow ups, which encompasses patient and payer follow-ups.”

Existing and new regulations also limit their choice of technology vendors, as does their need for platforms that integrate a variety of functions. They require solutions that dovetail items like payments, claims submissions, patient documentation, and patient care.

2. Waste Reduction

Beyond the general trend of technology investments, healthcare organizations desire to reduce waste, particularly in the area of revenue cycle management. This driver arises primarily from the transition to value-based care, as well as declining claims reimbursement rates.

With VocalRx, an automated call center solution from best-in-class TCN, medical providers reduce time spent on routine tasks like insurance denial notifications, lab test results notifications, and bill balances. Providers can also reduce needed staff. The percentage varies, but one TCN customer reported a 40 percent reduction in staffing needs.

According to a September Black Book Market Research report, nearly 60 percent of surveyed medical providers and 86 percent of surveyed hospitals plan to jettison some revenue cycle management functions. An operation of particular note is resource-intensive medical billing processes; providers and hospitals want to eliminate ones requiring hours of manual data entry or those prone to error.

Doing so certainly reduces waste, thereby saving the organizations money. However, the change in behavior holds additional benefits for the top and bottom lines. More accurate and efficient processes lead to better billing of and communication with patients.

3. Efficiency Escalation

Reducing waste is all well and good, but it gains more momentum when coupled with increased efficiency. As noted in the previously, medical providers and hospitals wish for more efficient processes. This will allow healthcare organizations to increase the number of claims submitted, decrease the number of rejected claims, and reduce time spent collecting payments.

VocalRx enables efficiency through automation. Medical providers and hospitals can automate routine tasks, which includes appointment scheduling and requests for payment. Using only the basic cloud call center, a TCN customer increased revenue collection by 327 percent.

Automated solutions offer a way to accomplish the goal. These platforms sift through ever-changing payer rules and codes. Many of them also prevent healthcare fraud and monitor claims for accuracy and compliance.

Michelle Tohill, Director of Revenue Cycle Management at Bonafide Management Systems, explained the reality to RevCycle Intelligence. “Keeping up with all the diagnostic codes and different insurance policies can be exhausting, but there are many software providers that will automatically update codes and requirements. This cuts down on your research time, allowing your billing team to spend more time double-checking claims to make sure they meet every single requirement.”

4. Patient Satisfaction

But reducing waste and increasing efficiency alone won’t successfully transform revenue cycle management. The true catalyst lies in the patient experience, especially as healthcare entities adopt the value-based care model and patients embrace high-deductible health plans (HDHPs) to save money on monthly premiums.

Besides reducing waste and increasing efficiency, VocalRx offers opportunities to improve the patient experience. The work occurs through automated reminders and self-pay options, as well as nonintrusive requests to answer short surveys.

The first customer mentioned, for example, experienced an increase in right party contacts (RPCs) by an overall 188 percent. They also reduced hold times by an overall 56 percent. The two items are essential to good customer satisfaction ratings.

McKesson, a technology vendor and advisor in the healthcare space, notes that patient self-pay will rise as a result of the HDHPs. However, the increase “need not yield a future of lower collections and higher bad debt,” they say. “The secret to success is more and better communications.”

Shawn Yates, a Texas-based healthcare expert, offers a similar opinion. “More and more focus is moving to how you interact with the consumer. This means providers need to understand what their outsourcing vendors are doing. Thus having tools to not only track performance but [also] how they handle critical items like complaints is extremely important. Having these tools in one platform along with your workflow helps you manage the process and keep an eye on all aspects of patient interaction including the outsourcing vendors.”

5. Analytical Intelligence

Finally, healthcare providers should embrace an analytics mindset. Better and more targeted data fuels their organizations. It keeps them solvent, yes, but it delivers greater efficiency, productivity, and patient loyalty.

VocalRx interfaces with most Electronic Health Records (EHR) systems, making it easy to see how improved communication — through automation — affects patient satisfaction and payouts.

George Dealy, Vice President of Healthcare Applications for Dimensional Insight, shares his perspective on the trend toward analytics and the need for it with Becker’s Hospital CFO.

“As the healthcare industry shifts to more risk-based contracts, organizations will need to start leveraging data insights from providers’ current revenue cycles. In addition to simply receiving these data insights, however, it will be equally as critical that the organization’s staff [members] are proficient at translating the rich information into actionable RCM improvements at the practical level. This will help ensure more well-informed, strategic business decisions in the year ahead.”

Healthcare is changing, and with it revenue cycle management. In response, medical providers seek technology solutions that reduce waste, increase efficiency, improve patient satisfaction, and deliver actionable insights.

TCN’s call center is one such tool. It merges with EHR systems so as to speed up reporting, decrease unnecessary expenditures, and enhance patient interactions. To learn more about how TCN can trim costs and generate profits, check out our savings calculator.