The Future of the Revenue Cycle
By Kimberly Corriveau, Director of Revenue Cycle, Central Ohio Urology Group
Healthcare revenue cycle is recovering from an extraordinary public health crisis and as the world changes to acclimate to these sudden changes, so are healthcare organizations.
This COVID-19 pandemic put a spotlight on the patients’ experience and urged government leaders to implement new laws. On Jan 1 2022, the “No Surprises Act of 2022” went into effect, which prohibits health care service plans, providers, and facilities from surprise balance billing patients out-of-network costs in specific non-emergent and emergent circumstances. This Act had a direct impact on the RCM and forced healthcare organizations to leverage current technology to ensure patients are informed of their out-of-pocket costs at the time of scheduling. Hospitals and providers had to quickly implement cost estimator tools, revenue cycle technology to flag patients who are out-of-network, and create hard stops in their billing systems to prevent automatic placement of patient balances.
We can see the future of healthcare is heading towards a digital revolution, as we shift from manual to more streamlined processes which encompass new emerging technology both in the clinical fields and in the RCM. Some of the major changes we have seen in the revenue cycle is the shift from onsite employees to remote working staff. This sudden interchange moved organizations and leaders to quickly apply new technology, such as add-on features to their current billing software program and ultimately pushing some originations to transition to a more robust billing software platform in order to optimize revenue and for better data analytics.
The RCM has numerous stand-alone software applications that include many interfaces and manual processes. As healthcare organizations continue to grow, it is imperative that their technology grows at the same rate. There are many things to consider when a healthcare organization decides to switch or implement a new software platform:
1. Include your financial department
It is important to consult both your financial and clinical leaders when implementing new technology. Unfortunately, many organizations don’t consult their revenue cycle leaders and experience a delay in payor payments and claims processing times.
2. Monitor changes
Set goals and track the areas you expect to see improvement, such as efficiency, optimizing your revenue, or improving the overall patient experience.
3. Identify and resolve barriers
Create a team to track the barriers being experienced during the transition. Identifying and resolving the root cause of these barriers is key to the success of your implementation.
4. Implement new policies and procedures
Create new policies and procedures that align with the latest software platform. You cannot hold your employees accountable if you don’t have a written policy or procedure.
5. Have resources available.
When you go live, its imperative to have recourses and live representatives available to help staff through the interchange experience.
As we continue to advance in healthcare, we can see many changes in the near future. Some of these changes include advancements in EMR, EHR, and clearing house technologies and the evolution from a fee-for-service model to a value-based customer-centered approach. In the AMA’s publication of The Collaboration Challenge stated, “It’s no longer enough to be a team player. To succeed in today’s highly dynamic and networked world, you’ve got to master the art of collaboration. And so does your organization as a whole.” This collaboration should encompass all healthcare providers, organizations, and insurance payors so we can start focusing on overall patient care and experience.
