As we move into 2023, there are several things on the minds of revenue cycle management (RCM) leadership, according to attendees of MDaudit’s recent webinar, Driving Growth and Improving Revenue in 2023. In order of importance, those are revenue opportunities (34%), compliance pressures (29%), revenue risks (29%), and staffing issues (9%). And for 37% of attendees, all those issues are top of mind as they enter the new year.
These concerns align closely with the focus on growth, revenue, and profitability that we’re seeing in most organizational planning – and is evident in the five key RCM trends for the coming year, which we originally identified in the 2022 Annual Benchmark Report.
1. Defending revenue will be as critical to health systems as growing revenue in 2023. A proactive revenue strategy is imperative. This is particularly true given the immense pressure coming from payers, especially on the Medicare and Medicaid side of the house, to ensure that every claim is scrutinized and properly adjudicated. Consider that 82% of initial claim denials came from Medicare – an increase of more than 20% over 2021. Thus, provider organizations need to have in place the processes and systems to defend claims and earn the revenue they deserve for the services they provide.
2. The role of billing compliance will continue to be increasingly data-driven and cross-functional, serving as a business partner to other teams to meet changing and more complex risks. Healthcare organizations are working to maximize their resources and do more with less. As part of this trend, we see a growing number of Chief Compliance Officers focused on collaboration and working cross-functionally across coding, revenue cycle, revenue integrity, finance, pharmacy, and clinical to tackle their revenue and compliance agendas. At the same time, revenue cycle management – and compliance in particular – is simply more data-driven than in the past. The line between a compliance problem and a revenue problem is growing thinner, which means risk must be monitored on a monthly or even weekly basis, which requires accurate data.
3. Resolving accuracy issues in billing and coding operations, which can help retain 15%-25% of overall revenue, is a high priority. In our analysis of billions of dollars of denied claims, we found that the average healthcare system can save up to 20% of its overall revenues just by making sure coding is done accurately and properly – and resources are not wasted on things like duplicate claims, missing modifiers, and billing issues. It’s why we are seeing significant investments into artificial intelligence (AI), coding solutions, and other software as the aspects of healthcare’s digital transformation journey that are capable of streamlining revenue cycle management and driving positive revenue outcomes.
4. Organizations will focus on monitoring their payer mix and the unique risks associated with each. All payers are not equal. The greatest risks for organizations increasingly dependent on federal payers are a larger burden of proof for timely payments, administrative costs, and defending audits – not to mention lengthening adjudication cycles. Thus, it is important as part of proactive RCM to monitor the mix of payers in a healthcare organization’s network and their payment trends on at least a monthly basis. Administrative costs must also be closely managed to ensure resources can be dedicated to pursuing the claims that matter most to the bottom line.
5. Powerful technologies, including cloud, AI, machine learning (ML), and predictive analytics, will catalyze health systems to proactively monitor and quickly address compliance and revenue risks as they emerge. All the previous trends present real opportunities for healthcare organizations to build a strong business case for deploying advanced technologies and use it to drive outcomes. The use of AI, ML, and analytics is no longer theoretical, but rather is now being put to practical use in real-life scenarios.
An Integrated Revenue Cycle Management Solution
In today’s revenue cycle management, the best revenue defense comes from a powerful technology offense – a solution like MDaudit Revenue Integrity Suite, which brings together proven integrated risk capabilities and workflows into a single platform. By redefining claim denial mitigation, Revenue Integrity Suite identifies and prevents 20% of high-value hospital charges that drive 80% of denials impact – helping one West Coast health system retain more than $2 million in revenues in the first six months after deployment.
Interested in seeing a quick product video of a solution that will transform how you predict and mitigate denials? Click here to view the quick video.
