The healthcare landscape is undergoing a potentially seismic shift, and health systems must proactively respond to the challenges and opportunities this transformation presents. This includes navigating today’s healthcare challenges with increased audit risk, systematic payer denials, and a variety of shortages being experienced across the industry.
Impact on Hospital Revenue Streams
MDaudit’s 2023 Benchmark Report has tracked a sizeable increase in patient volumes and surgical procedures in 2023. The report also noted that hospital revenue and margins remain threatened by ongoing issues such as inflation, staffing shortages, reimbursement concerns, and regulatory challenges.
According to Kaufman Hall, healthcare leaders expect modest operating margins in the future. Nonprofit hospital leaders project a slow climb back to operating margins of 3% to 4%, indicating the need for proactive decision-making around protecting bottom lines. Organizations must reassess their strategies to proactively protect margins without compromising on quality, and technology is key.
Strategies for Protecting Hospital Revenue
Healthcare systems are learning how to do more with less, collaborate intentionally within internal teams, and foster an environment that holistically provides better outcomes for all. Here are some ways to contribute to strategies for protecting revenue integrity across the continuum.
- Technology Investment – To maximize doing more with less, healthcare systems must invest in the same AI-driven technology utilized by payors. Such technology will help identify at-risk billing patterns, along with the true root cause of denials, equating to increased cash flows and decreased accounts receivable.
- Incorporate Prospective Audits – The importance of looking at the integrity and accuracy of your billing on a pre-bill basis is critical to ensuring that reimbursement is maximized, and denials are mitigated.
Safeguarding Hospital Revenues through Collaboration
An important pivot necessary to safeguarding revenue – is breaking down team silos and creating synergy across cross-departmental collaboration.
When an organization employs the appropriate technologies, all stakeholders along the revenue cycle continuum will be working from the same insights and data. This organically breaks down silos and creates a unified front for all departments to combat ever-changing payor policies and scrutiny.
Employing technology consists of more than streamlined communication, increased productivity, and collaborative workflows. The right technology will also be instrumental in providing ongoing insights that are instrumental in provider education. Knowledge is critical in ensuring that destructive habits and patterns are broken.
Interested in learning more? Take a look at MDaudit’s Revenue Integrity Suite solution.
