Industry Trends Impacting RCM in 2016

This article originally appeared on HIS Talk

Higher out-of-pocket costs, new reimbursements models, and rising operating costs are just a few of the trends that will impact provider revenue cycles in 2016. These industry developments will force providers to evaluate existing RCM strategies and possibly implement new technologies and workflows to simultaneously maintain financial health and address evolving consumer and regulatory demands.

Consider some of the more significant trends and their potential impact:

Higher out-of-pocket costs for patients

As the cost of insurance continues to rise, patients are shouldering higher out-of-pocket costs for deductibles and co-insurance. As a result:

  • Consumers are paying more attention to the cost of care and requesting greater price transparency prior to receiving services.
  • Providers need efficient tools to estimate a patient’s out-pocket-costs. This includes accurate eligibility and co-pay details, up-to-date information on a patient’s deductible status, and specifics on what services are included in a patient’s coverage.
  • Consumers may need help managing the cost of their care. Providers may require automation tools to facilitate any special payment arrangements.
  • Existing workflows may need to be altered. For example, in the past a practice may not have verified insurance information until the patient arrived in the office. Administrators may now elect to verify insurance details in advance of scheduled appointments and advise patients when a large out-of-pocket cost is anticipated.
  • Providers face greater financial risk. When patients struggle to pay for services, providers risk losing revenue and must dedicate additional resources for collection efforts.

Overhead costs are rising, but not necessarily reimbursements

In order to preserve financial health, providers must:

  • Remain diligent in controlling costs and managing the revenue cycle.
  • Consider technologies that automate RCM processes and increase efficiencies.
  • Make sure staff is well trained in order to maximize the benefits of technologies.

Provider reimbursement models are shifting from traditional fee-for-service to models that include incentives for the efficient delivery of quality outcomes

RCM is no longer as simple as sending out a claim after a patient office visit. Instead, providers must:

  • Be proactive in managing the health of their patients.
  • Implement workflows and technologies to help track patient outcomes.
  • Improve care coordination to minimize test duplication, manage costs, and enhance outcomes.
  • Prioritize efforts to collect patient payments at the point of care or in advance of procedures.

Meaningful Use and the transition to ICD-10 are less of a priority

Meaningful Use and ICD-10 have been top priorities for providers for the past several years. Today, however, most organizations have implemented certified EMRs and achieved some degree of Meaningful Use success, as well as made the transition to ICD-10. Providers now have more time and resources to address revenue cycle needs, possible platform upgrades, and the addition of apps to increase operational efficiencies.

In recent years, RCM has taken a back seat to competing priorities, but the changing healthcare landscape is forcing providers to evaluate existing strategies and technologies. This could be the year that RCM emerges from the shadows and perhaps into the spotlight.

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