Forbes Council: The Future of Healthcare Revenue Cycle Management

By Sagar Rajgopal, Ubiquity

You may be forgiven for thinking that the healthcare industry was rolling in profits over the last two years. In reality, many healthcare facilities and providers faced the greatest threat to their survival ever during Covid-19.

The pandemic severely overwhelmed hospitals and increased hospitalizations threatened to hamper the healthcare services industry. Many facilities cut salaries and laid off staff. Now, they are seeking payments from a patient base that’s mentally and financially depleted.

It’s unsurprising that Covid-19 has served both as an agent and an accelerant in driving significant trends in healthcare revenue cycle management (RCM). What we see is a mixed bag of regulatory changes, rising patient-as-a-payer burdens, growing reliance on automation, and tremendous cultural shifts that place employees in their homes.

More Self-Paying Patients

Patients increasingly are selecting high deductible health plans (HDHPs), which charge low monthly premiums but have high deductibles. Patients are either self-paying for their care entirely or partially through HDHP memberships, both of which increase strains on collections. The pandemic further compounded the issue, with millions of people losing their livelihood, their health insurance or both. Businesses also canceled medical insurance for employees when it became clear they would be shuttered for an extended period, forcing patients to cover healthcare costs by themselves.

An Urban Institute analysis found that more than 3 million Americans lost job-based coverage over the summer of 2020. Providers need to work with, and not against, overextended patients to achieve higher patient payment rates since they now constitute a larger slice of the payments pie.

Healthcare providers must deploy a multifaceted response rooted in knowledgeable agents, data-driven analytics, and high-quality customer care that will squarely tackle the imminent challenges and seize the opportunities ahead.

Improving their early-out services, like engaging with patients shortly after discharge to explain the difference between patient and insurer responsibility, has shown to significantly reduce accounts that go into collection. But that kind of pain-point exploration demands more resources, including specialized training and expertise that most providers either don’t have yet or can’t manage on their own.

Where Automation Doesn’t Help

The challenges of Covid-19 also compelled providers to automate complex workflows to drive efficiency and minimize costs. Providers are automating more components of their revenue cycles, with 78% of health systems reporting RCM automation. Still, processes like claims management and follow-up communications largely remain manual due to the challenges around executing workflows that require collaboration between multi-party systems, which are constantly undergoing configuration changes by their own internal teams.

On top of that, patients often find tech-enabled customer support for healthcare frustrating. Fee schedules can’t necessarily be automated since they change regularly and are negotiated on a case-by-case basis between insurers and providers. While automation promises to accomplish a lot, it requires continual oversight and management.

Improvements to automation within RCM will continue into the foreseeable future, but the challenges will continue to be:

  • Fragmentation of the U.S. healthcare system.
  • New risk arrangements that are quickly replacing fee-for-service models.
  • An ever-growing diversification of RCM and claims software.

Because of these factors, human intervention will be key in ensuring providers are being reimbursed and compensated in a timely manner. Efficient coordination with payers on denied or misdirected claims and concise coordination with patients to collect or make arrangements to capture their out-of-pocket responsibilities will continue to require specialized vendors who focus on handling complex healthcare contact center services.

For the complete article, visit Forbes.

Forbes Council Member

Sagar Rajgopal is the co-founder and COO of Ubiquity and a member of the Forbes Business Council. Sagar works with clients to ensure that Ubiquity serves as a strategic partner that goes well beyond simply delivering KPIs.

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