2020 Healthcare Revenue Cycle Management Trends
The healthcare industry’s revenue cycle management (RCM) struggle is almost the same as trying to deliver a consumer-centric approach to have it more acceptable and delivering the pinnacle in financial experience to patients. The year 2020 seems promising to have an end in these struggles with the help of elite revenue cycle management companies with their healthcare revenue cycle management services since “price transparency” is being implemented by the administrations.
The other impacts being discussed in this blog includes the current promptness including the ones implemented and that we could see as 2020 progresses.
Price Transparency – What is it, its impact, and associated risks?
Price transparency protects patients from the expensive “surprise billing” issue. Hospitals and clinics are to make their service costs and insurance coverage price and even inform the consumer about the quality of the same. Providing treatment cost estimates to patients through new tools will help them go for affordable, credible, and honest service providers.
The impact of healthcare price transparency is that there will be an increase in the value of healthcare and innovation in the sector. The pricing information will be publicly available for all diagnostic testing, procedures, and medication, in a way that is easy to understand. These will be:
- Price transparency on services or products, medical tests or prescription drugs
- Quality of care or health outcomes are indicated as key differentiators next to each medical product or services’ price
- Uniform pricing data format making options for comparison easier
- Helping patients make the right decision via. counselors or smart apps guidance systems
- Out-of-pocket expenses can be carefully managed without making decisions based only on one person’s opinion.
An issue with price transparency - proprietary information and good deals will be made public
The associated risks with price transparency can be the following :
- Service provider resistance
- Disclosure of proprietary business information
- Confusion and chaos is expected to rise in the healthcare industry at huge scales this year
- Competition among providers regarding costs
- While revealing good deals, the deal is prone to be lost due to disclosure. It could also cause prices to go up and trigger massive confusion
- Possibility of unlawful collusion between two parties
- Effectiveness of selective contracting by health plans may get undermined thus hampering the country’s overall healthcare setup
Quality Care is All that Matters in 2020
Quality of patient care will be the prime focus of the healthcare industry in 2020. The technological advancement of outsource healthcare data entry services or medical data entry services, health insurance data entry, etc. provided by offshore medical data entry companies in the price transparency era will remarkably free up healthcare organisations from their major back-office hassles in the long run.
Even the outsourcing criteria will be based on the top 10 healthcare revenue cycle management companies or an even top 5 prominent range. The other heavy reliance will be on evidence-based clinical criteria to measure and deliver quality patient treatment and its outcomes. As this would become a standard practice in 2020, the other aspects that would be given due importance to the treatment assessment and how it would benefit patients.
What is the emphasis of ‘Quality’ in Patient Care ?
The hindrances faced by healthcare organisations while providing medical facilities are often faced by many issues. These could be the unavailability of competent staff, unhygienic infrastructure, poor access to high-quality medication, poor documentation processes, etc. So, countering such factors is crucial to a healthcare organisations where quality would be a defined standard or norm.
The Definition of ‘Quality’ Patient Care in 2020
The following aspects would define quality for patient care in the 2020 era:
1. Patient Safety : Highly reducing medical practice negligence and preventing injuries and risks ensuring the safety of patients as the number one priority.
2. Scientific Backing : Ensuring every treatment or care will be carried out based on in-depth scientific research and knowledge, that utilises a foundation of proven data.
3. Promptness : Complete elimination of delays for patient care.
4. Efficient Resource Utilisation : All medical and other related resources will be utilised in its maximum potential that highly avoids wastage.
5. Unbiased Care : Patient care will be given in an unbiased manner irrespective of patient gender, ethnicity, economic or financial capabilities, etc.
6. People-centric : Care that considers individual preferences and their cultures.
What Standards will be Implemented in 2020 for Improving Quality in Patient Care?
1. Addition of more competent healthcare professionals, and basic physical resources, proper supplies, and medical equipment.
2. Unbiased patient communication should be made more effective with solid support system access, informing them at every phase of the treatment process, as it is their fundamental right.
3. Build trust among patients by motivating and engaging them in community activities, provide the needed help, creating greater awareness, and patient bonding.
The Role of Revenue Cycle Management (RCM)
Patients will be facilitated with the necessary tools through healthcare revenue cycle management services or RCM services keeping them patients away from the competition of price transparency to manage the expenditures brought in from their own hands.
The reason behind this is that such expenditures equally affect the uninsured and the insured when money is paid from their own hands’ post insurance payment. So for RCM Managers to keep their business unaffected, they make such payment options easy and painless.
Interest-free payment plans, online self-service, and other attractive payment arrangements are other features likely to be offered in 2020, besides price transparency.
The Price Transparency Advantage to RCM Managers
1. Insisting providing real-time access to cost estimates and provide a price estimate and abide by it, to beat the competition via. online tools although not exactly dependable in figuring out the accuracy of costs.
2. Providing comprehensive visibility of finance across the revenue cycle continuum.
3. Adopting highly advanced technologies to centralize operational processes that merge various operations ensuring higher interoperability and uniformity levels, generating useful data that is complete, and holistic.
4. Different and attractive interest-free payment or other easy term payment systems will be introduced by RCM managers for patients getting intimidated by high payment costs and settling for cheaper providers.
5. Integration of new and enhanced technologies such as RPA, machine learning, and cognitive automation with digital self-service platforms that offer patients a more personalized and end-to-end experience.
6. Data-driven algorithms will help in predicting a patient’s ability and willingness in settling their healthcare bills. This prediction will also help in tailoring interest-free treatment plans to patients through facilities such as mobile apps, websites, or kiosks from the provider, revolutionizing patient experience. This will also encourage and enable patients to schedule their appointments, pay bills or even manage healthcare finances on their own with the mentioned technologies.
7. AI and Predictive modeling will be implemented providing patients with accurate bill statements at minimal turnarounds compared to the previous monthly delays, eliminating RCM hold-ups.
Quality Care will have an Edge over Business with Price Transparency
The implementation of price transparency requirements in the healthcare sector continues to evolve, healthcare providers would be forced to focus on quality patient care by outsourcing their entire RCM process to revenue cycle management companies providing healthcare revenue cycle management services.
This would also mean that the increased competition would make healthcare providers prepare themselves for minimal profits, diminishing reimbursements, climbing claim denials, patient satisfaction-tied reimbursement process, etc.
This is the future of the healthcare industry and the trends that would be affecting it from 2020 and beyond, where patients would have a more valued focus from healthcare providers, rather than carrying out pure business.