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RCM Technology: Trends That Will Shape the Revenue Cycle in 2024 

Authored by: Tim Anderson, Executive Vice President of RCM, Healthcare 

Healthcare company mergers and acquisitions are on the rise. During the first three quarters of 2023, 53 hospital mergers were reported, but hospitals aren’t the only organizations experiencing higher consolidation activity.  

 

Healthcare payers are also seeing an increase.  

 

As these changes take place, payers adopt new systems, producing gains in efficiencies, and if medical providers aren’t prepared, their revenue cycles could be impacted. Here are a few RCM technology trends to watch for in 2024, along with steps you can take to position yourself for future advantage. 

Automation grows on the payer side 

The number of payers using automation is on the rise. The good news for providers is that increased payer automation can translate into faster claims processing. But the not-so-great news is that providers might experience an increase in denials.  

 

Why? 

 

Payer automation operates at a level that might not include a back-end human review of the claim. So, yes, the process is happening faster, but it doesn’t always have the benefit of a human saying, “Oh wait, I understand this.” Losing that human touch could result in more denials.  

 

Part of the solution is integrating automation into your claims process to decrease the risk of claims denial and increase first-time claims approval, which is also your best opportunity for capturing the most revenue. 

Artificial intelligence is quickly becoming the norm  

Leveraging artificial intelligence is quickly becoming the norm and will continue to transform how reimbursement happens – and its speed. But it could also support the shift we’re seeing to value-based care and the need to track specific metrics.  

 

As payers require value-based care metrics around diagnosis and management of patient care, tracking the necessary data will continue to be critical, especially in the primary care world.  

 

Healthcare payers are adopting technologies to support value-based reimbursement, but we haven’t seen the same rate of adoption from providers. In fact, we’re nowhere near the “maturity phase” for providers yet. But with more reimbursements moving to value-based models in the future, it’s important to consider whether your existing tools align with that future.  

Action plan to capture an advantage  

Providers are busy, often working hard to keep up with what’s happening now and ensuring revenue cycles are healthy. And that’s important. But you can also take proactive steps to position your revenue cycle so it is stronger for the future. A few areas of focus include:  

  1. Becoming a student of value-based medicine. Research shows that roughly half of healthcare payments are made through value-based reimbursement models. And experts predict its continued growth. Understand how value-based reimbursement influences your revenue cycle, have conversations with your payers about how it works, and then learn how to best leverage it in your practice.  

 

  1. Using revenue cycle technology to ensure you’re getting paid correctly. A surprising number of practices lose revenue by not getting paid in accordance with their contracted rates. An automated system can help you verify that every payment that flows into your practice is paid in accordance with the appropriate allowable amount based on your payer agreement. This action alone can help significantly improve your revenue cycle.  

 

  1. Keeping watch on prior authorization trends. Prior authorizations made a comeback post-COVID. The ability to streamline processes around requirements is critical to maintaining future revenue cycle health.  

If you’re still relying heavily on legacy systems or manual efforts, such as charge capture, you’re likely spending more money and resources than needed. Practices that strategically embrace revenue cycle management technology provide a strong advantage and often recapture lost dollars.  

If you need help figuring out how to get started while preparing for the future, a revenue cycle specialist who understands RCM technology can help.  

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