Top 5 Challenges Affecting Revenue Cycle Management Services in 2023

 

Revenue Cycle Management (RCM) is an integral part of healthcare systems and helps keep bills paid, denials low, bills paid, and revenues flowing. While some practices opt to handle Revenue Cycle Management services in-house, most of them take the help of third-party service providers to handle the most important part of their backend operations. 

 

RCM strategies and processes keep getting updated over time. Every year, RCM experts need to learn, unlearn, and relearn what they know if they want their skills to be relevant. Here are five top challenges affecting Revenue Cycle Management services in 2023. Handling these challenges would help improve the services rendered and make a difference.

 

1. The importance of prior authorization and verification

 The insurance payers are going to require more services, and patients have prior authorization before they receive a service. With the need to quickly get appointments and treatments offered to patients to improve patient experience and check and get prior authorization to offer these services to the patients, the administration team will always be running short of time. 

 

Investing in automated prior authorization processes as a part of Revenue Cycle Management services would be the only way to handle this.

 

2. More patients who self-pay

The entire process of billing and collecting reimbursements changes when a patient opts to pay out of pocket. With more patients choosing high-deductible healthcare plans, the Revenue Cycle Management service teams need to know exactly how much the payer and co-payer would be paying and bill accordingly. 

 

With such complex payment processes, the final collections get affected.

 

3. Changes in regulatory conditions

It is no surprise that the payers keep updating their terms and conditions often. This means that Revenue Cycle Management service providers need to be in a constant state of learning. This may sound simple on paper, but it is extremely challenging in reality. A biller or a coder is extremely busy at work, and finding the time to take up training and learning courses may throw their balance out the window. 

 

4. Need for technology beyond automation

Automation is the first and most commonly used technology in Revenue Cycle Management services. Experts believe that most of the problems in RCM can be solved with automation. That is not the case in 2023, though. Automation works when the base factors remain the same. When base factors change, automation may fail.

 

Take, for instance, generating fee schedules. Hospital service fees can change regularly and are often case-dependent. Hence practices may need to invest in AI or ML-based technologies that think and act, unlike automation.

 

5. Data mining and analytics

It isn’t enough for Revenue Cycle Management service providers to merely handle RCM operations and generate money. Healthcare providers want these service providers to go one step extra and handle data mining and analytics as well. There are several terabytes of data generated in healthcare industries as a part of RCM. These vast amounts of data can be mined to identify patterns that can help the business improve. So it is vital for RCM service providers to invest in analytics too.

 

Conclusion

Tackling these top five challenges in Revenue Cycle Management services will help service providers put their best foot forward and create changes that add value to the healthcare provider. 

 

Practices that work with RCM service providers who understand these challenges and have processes in place to rise above them would only be able to grow and sustain in today’s competitive market.