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Priorities for RCM Leaders in 2024

Kevin Holst
January 31, 2024
RCM priorities

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The key phrase for revenue cycle management organizations throughout the healthcare industry in 2024 will be technology innovation. RCM leaders will use automation, AI, data analytics, and others to manage a host of issues in 2024. These challenges include workforce shortages, denial management, improving the customer experience, and more. Let’s take a closer look at the top RCM priorities in 2024.

It starts with automation

The greatest technology adoption in healthcare is going to involve automation, specifically to drive efficiencies in the back office. More than one-third of health system executives plan to automate two or more revenue cycle management or financial functions in 2024.

Another key area of technology investment is in data and analytics.

RCM priorities

Generative AI has aroused interest in health services and technology. However, use case development and deployment are in their early days. And some payers and health systems have already invested in data analytics (as well as related infrastructure and governance). This should lead to a greater focus on use cases that enable clear, near-term operational value.

Given that investment in technology has underwhelmed many in the healthcare industry in terms of productivity gains, it will be essential to implement AI in the best way to fulfill its promise.

Overall, it looks as if 2024 will see more point solutions being adopted in critical healthcare-specific business functions, such as RCM.

Managing workforce challenges

According to the American Hospital Association, there will be an estimated shortage of up to 3.2 million healthcare workers by 2026. This includes many openings in RCM departments.

Unfortunately, a readily accessible talent pool isn’t appearing on the horizon anytime soon. So RCM leaders will continue to look to remote employees and automation to fill in the gaps.

By 2025, an estimated 32.6 million Americans will be working remotely, which equates to about 22% of the workforce. This projection suggests a continuous, yet gradual, shift toward remote work arrangements. And automating many RCM processes will not only help get new remote employees up to speed and productive more quickly, but it will also help leaders evaluate and manage employees who aren’t sitting in the next aisle.

Automation can also help alleviate the workload on your current staff. Time-intensive tasks, such as manual and repetitive inputting, processing, and evaluating of documents and data, can be automated, eliminating human errors and allowing employees to focus on more human-intensive tasks.

The world of denials

Denials continue to increase, with 89% of all hospitals and health systems reporting a rise in denials during the past three years.

RCM leaders will turn to robotic process automation (RPA) to help with the long, arduous denial management process. With RPA, the denial process can become more efficient, saving valuable time for your staff as well as your patients. RPA can help with:

  • Incorrect/missing information: A bot can be directed to log into various systems and look through each system for incorrect and missing data. The bot automatically updates the account if any information is found.
  • Invalid coordination of benefits/no coverage: A bot can be directed to conduct an eligibility check. It can check various systems to search for coverage options and make appropriate updates based on provider guidelines.
  • Additional documentation required: A bot can be directed to gather all necessary material as directed by the insurance company. This includes such things as medical records, pre-authorization details, clinical notes, and more. The bot then creates a PDF of the required documentation and submits it to the insurer.
  • Adjustment postings: A bot can log into the system of record, then create an adjustment transaction.

Improving the patient experience

RPA will also be a critical tool in automating other RCM tasks that ultimately will help improve the patient experience.

Automation enables RCM staff to get a better understanding of what they can expect from an insurance provider and how soon they can expect it. In turn, employees can organize details from a patient’s appointment and provide a statement or bill much more quickly. Receiving a bill sometimes months after an appointment or after receiving medical treatment is frustrating and negatively affects the patient’s perception of their experience.

And, in an era when trust in healthcare providers and organizations has diminished, focusing on improving the customer experience will be of vital importance for RCM organizations in 2024.

For example, having employees available for patient interaction can boost public confidence and perception. Automation can help make this happen. Artificial intelligence (AI) and machine learning (ML) can be used to better understand the patient and their communication and payment preferences. This information can help RCM staff connect with patients where, when, and how they want to engage. And those connections including digital channels, such as text and email. It also gives staff information on all available insurance options, as well as details on any other coverage and payment options. Presenting patients with this information as soon as possible, even before treatment begins, improves the overall patient experience by giving patients a great sense of control over the process.

Automation can also help in other areas of the patient experience, including with Medicaid redetermination.

It is estimated that Medicaid enrollment could decline by about 10 million individuals during the next five years. RCM organizations can use technology to help patients apply for coverage, either early in the process before any treatment begins or even after treatment has been provided.

Better prepared for 2024

As RCM organizations enter 2024 with a host of projects lined up, one of those should revolve around an increased investment in RPA and other technological innovations. If the recent past has taught us anything, it is that technology will be critical to successfully handling today’s issues and preparing for tomorrow’s challenges.

RCM leaders can’t anticipate all the potential struggles facing them in the year ahead. But by embracing technology innovations early, RCM leaders can better position themselves to manage whatever comes their way.

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