The start of a new year invokes excitement and anticipation for what is to come. For hospitals and healthcare organizations working to improve revenue cycle management (RCM) processes, this new year will likely evoke feelings of trepidation as many of the issues plaguing RCM leaders will drag into 2023.

But there may be light at the end of the tunnel for some of the most troublesome pain points. Let’s take a look at what’s awaiting hospitals and healthcare organizations in 2023.

Labor Shortages

The workforce landscape has changed dramatically since the global pandemic forced many employees to shelter in place and work remotely. Corporations around the world laid off staff in response to the resulting reduced revenue. Hospitals and healthcare organizations were not immune, laying off staff as patient volume decreased.

As restrictions have relaxed, companies have discovered a shift in worker priorities, with many individuals preferring to work completely remotely or in a hybrid environment. In addition, soaring wage costs, implementation of sign-on bonuses, outsourcing of jobs, and greater use of automation have all played a role in mitigating the current staffing shortages at many hospitals and healthcare organizations. And now that patients have started to return, they are struggling to fill positions.

In a recent survey, nearly half (48 percent) of healthcare organizations said they were facing a severe shortage within their revenue cycle management or billing department.

With these shortages expected to continue into the immediate future, healthcare providers are considering outsourcing their RCM processes more than ever before. Those who plan to keep RCM in-house are turning to technology to streamline the process.

Margin Struggles

Healthcare leaders are looking at all possible avenues to reduce expenses, including their RCM processes. Finding ways to accelerate the path to account resolution has become critical as they attempt to collect payments more quickly and efficiently. Many are looking to technology to guide the way.

Whether brought in-house or used by an outsourcer, an innovative RCM solution can help organizations prioritize accounts that not only produce higher yield, but also have a better chance to close quickly, as well as those with a higher likelihood of closing.

Denial Prevention

Like it or not, denials are a part of the healthcare industry. But this inconvenient aspect of healthcare can also be expensive for hospitals and patients. While claim denial rates vary among different organizations, one report shows that the overall healthcare industry has seen a 20% increase in claim denial rates in the past five years. creating significant cash-flow issues.

Yet, much of this is preventable. Recent information from HFMA shows that 90% of denials are preventable, with prior authorizations contributing to 42% of those root causes. Part of why claims are denied due to prior authorizations is the lack of visibility into changing insurance requirements and knowing when a prior auth is needed. Obtaining visibility into shifting payer rules as well as key performance metrics is critical in the search for solutions to this problem. This is part of a greater push by organizations to move from reactive denial management to proactive denial prevention.

Purposeful Automation

As cost issues and labor troubles push into 2023, hospitals and healthcare organizations are turning to technology to help alleviate some of the pressure.

According to a recent report, software is a top five strategic priority for nearly 80% of health provider organizations. And more than 95% of providers expect to make new software investments, with RCM being the top investment area. Much of these investments will be made with automation in mind.

By removing time-consuming tasks that can be accomplished via automation, organizations can uplift the value that their teams bring to the table while also improving the experience and results for patients and staff alike.

Encouraging Outlook

Many of the top issues plaguing healthcare organizations in 2022 will continue to linger into 2023. But the new year will see hospitals and healthcare organizations look to automation to resolve many of these issues — whether using this technology in-house or turning to an outsourcer.

With the help of automation, hospitals and healthcare organizations should expect more efficient processes, more productive employees, and a healthier revenue stream.

This is the first in a series of articles exploring trends in the healthcare, ARM, government, and payments industries. Stay tuned for the next article.

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