The Only Constant is Change: Trends Impacting Healthcare Revenue Cycle Management in 2021

“It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.” 

Charles Darwin said this about the natural world, but it’s a truism that could also apply to healthcare revenue cycle management in 2021. Changes to protocols and standards happen rapidly, even in a good year, but the pandemic put healthcare RCM into a tailspin. It’s essential to be on top of these changes, or you’ll get left behind. New legislation and shifts to work from home post-COVID will dramatically affect healthcare RCM methods and cybersecurity standards. Here’s how these trends will impact your workflow for the coming year.

 

Increase in Remote Work 

Billing and accounts teams in healthcare are frontline-adjacent. Even though the work never stopped, billing and accounts teams were rapidly forced to switch to remote work. The increase in security and compliance controls that this triggered is not expected to go away. Rather, dual hybrid and remote work models will become the norm for billing and accounts teams. Around 75% of health systems and large hospitals have considered permanent staffing changes that include work from home. Therefore, your RCM procedures must be able to work as well at your home office as they do at the hospital. 

 

Increase of Patient as Payer 

With increased denials by insurance companies post-COVID, individual consumers will begin to carry the financial responsibility for their procedures. This switch has left healthcare organizations struggling to collect payments promptly, as they are only familiar with the behaviors of larger payers, not individual consumers. This slows down the entire RCM process and is becoming a genuine revenue concern at around two-thirds of healthcare organizations. These consumers have very different cycles than payers, so it will be essential to pay attention to the data to find new best practices that engage the consumer to ensure that the payment takes place. 

 

Increase in Consumer Collection Laws

This legislation is aimed at protecting individuals affected by the COVID-19 public health and economic crisis. It restricts surprise billing practices and will force a greater focus on compliance. Billing cycles and standards may change, so it’s important to keep your RCM practice compliant, so you’re not risking losing out on any reimbursement because of a clerical error. In particular, you should pay attention to the CFPB (Consumer Financial Protection Bureau) rule, which goes into effect on October 1st. This rule lays out new standards for electronic communications, which will apply to digital medical debt collection. 

Read more about the “No Surprises” Act here!

Increase in Cyber Security Issues

Data breaches cost the healthcare industry $7.13 million annually. With some of the changes mentioned above, such as increased legislation surrounding consumer collection laws and work-from-home practices, good cybersecurity will become a crucial part of any healthcare RCM. Healthcare data security incidents have been on the rise, and sensitive patient information is always a vulnerable target. The price of a breach is greater than the price of protection. Your standards may seem like they are working now, but it’s easy to become complacent. Make sure your RCM practices are up to par with industry-standard cybersecurity protocols. 

 

Increase in RCM Automation

At first glance, this seems like a great thing as so much of the billing process is manual. Automation will save time for the billing and accounts team and will result in more timely collections from payers and patients. To handle new modes of care, like telehealth, however, these systems of automation will have to be intelligent and scalable to keep up with the increasingly complex payer rules. Traditionally, automation in the healthcare billing sector has been driven by rules-based technologies. As complexities in medical reimbursement evolve, however, a switch to intelligent automation driven by machine learning can help keep up productivity. 

If you are having trouble maintaining cybersecurity while trying to switch to RCM automation or if you’re simply confused by the CFPB rule and consumer collection laws, give us a call! We can make sure your practice is up-to-date on the new standards in the post-COVID healthcare world. 

Our expertise helps you get the most revenue back from your anesthesia services, and it saves you time and money. For a free consultation, contact us!