Healthcare is one of the industries that experienced the most upheavals in 2020. The COVID-19 pandemic has thrown up urgent needs and new challenges for revenue cycle management (RCM), which will make reliable medical billing and coding services all the more important. Let’s take a look at the major challenges and predictions for RCM in 2021, according to recent reports.

Reports Identify Upcoming RCM Challenges

A recent survey conducted by KLAS and the Center for Connected Medicine noted that, among other things, healthcare leaders consider RCM as an area in healthcare with the greatest need for innovation (www.healthmanagement.org).

According to the Top of Mind for Top Health Systems 2021 (Top of Mind) report, up to 75% of the respondents were optimistic about seeing innovation in RCM in 2021. Notable observations:

  • Areas such as coding and billing benefit greatly from RCM.
  • More regulatory changes were needed for price transparency.
  • Telehealth would play an important role in impacting revenue.
  • Technology would help track revenue cycle data and decision-making.
  • Predictive analytics, AI, bots and automation are seen as significant for RCM efficiency
  • Proactive focus on key front-end RCM steps which include scheduling, patient registration, insurance eligibility and authorization, and upfront patient collections. Back-end RCM processes include claims management, medical billing, and final patient financial responsibility collection.

The fourth annual KLAS and the Center for Connected Medicine research survey covered 117 executives representing 112 healthcare provider organizations and focused on how innovation priorities changed due to COVID-19 and the role of innovative technologies in managing the pandemic.

Another new report titled “Top health industry issues of 2021: Will a shocked system emerge stronger?” from research and consulting leader PwC predicts six major challenges in 2021. As reported by www.healthcareitnews.com, these concerns are:

  • Rightsizing after the telehealth explosion
  • Adjusting to changing clinical trials
  • Encouraging digital relationships that ease physician burdens
  • Forecasting for an uncertain 2021
  • Reshaping health portfolios for growth, and
  • Building a resilient and responsive supply chain for long-term health

Healthcare provider executives who participated in the PwC’s Health Research Institute survey most frequently cited mental health and psychiatry (58%), family medicine (56%), obstetrics and gynecology (46%), and pediatrics (44%) as the specialties in which their organizations will offer virtual visits in 2021. However, the report notes that payers would be grappling with telehealth reimbursement. The report identifies winners as those who will successfully blend virtual and in-person care, and leverage new consumer- and clinician-facing digital health tools.

“Tying virtual to in-person seamlessly is important for reducing leakage and maintaining ancillary services, follow-up appointments and prescription levels,” said researchers. “Better integrating virtual patient visits into a care pathway makes for improved care and reduces dropped handoffs.

Outsourcing Recommended to Improve RCM Efficiency

Outsource medical billing companies could provide the solution to the current economic crisis facing providers, according to a recent report from Revenue Cycle Intelligence. The October 2020 article notes, “Outsourcing full revenue cycle management to a third party could help some cut costs while focusing on patient care.”

Though a critical process, RCM is complex and as a result, healthcare providers struggle to maintain efficiency. To improve medical billing efficiency and revenue, hospitals and practices implement technologies, workflow overhauls, hire additional personnel, etc. However, while these strategies can improve revenue, they can significantly increase costs too and take away resources from patient care. The report points out that outsourcing RCM has proved a useful option for organizations that have such resource constraints and helps them implement strategies that can enhance revenue capture and collection.

However, the Revenue Cycle Intelligence notes that success with RCM outsourcing depends on partnering with the right vendor. Healthcare organizations need to understand the capabilities of the medical billing company they choose and communicate with them through regular meetings to track progress. The report lists other attributes that providers need to look for when selecting a vendor as:

  • Accountability and stability
  • Cultural fit, with shared values and aligned goals
  • Lower overall cost structure, while maintaining performance
  • Access to consistent, advanced revenue cycle technology
  • Ability to scale operations
  • Access to centralized pools of talent

With a responsible medical billing service provider, healthcare organizations can reduce costs, ease administrative burdens, and maximize reimbursement as they focus on patient care and well-being.