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Revenue Cycle Management Trends and Challenges for 2019

January 8, 2019

Healthcare-Trends-and-Challenges-for-2019Highlights of 2018 Reviewed

2018 has been quite a year within the healthcare industry for patients, providers and especially medical claims billing. Knowing what to expect can help you to improve and strengthen your own medical billing strategies in 2019 and beyond. Over the past year, we’ve seen new trends and changes in the following areas:

 Patients (however reluctantly) becoming the biggest payers as the insurance industry shifts more responsibility to the patients.

  • The shift to value-based care continues to transform healthcare, bringing with it changes and challenges to the billing, reimbursement and revenue cycle.
  • With this shift comes increased expectations from patients for their healthcare providers, whether in services provided or making the payment experience more seamless and patient-friendly, including  having the option to pay larger balances over a period of time.
  • Medical billing has experienced incredible growth in the use of artificial intelligence (AI) to remove some of the more repetitive billing tasks while improving accuracy.
  • An increase in outsourced billing is helping providers improve billing accuracy while better managing staff and clinicians’ time. Moving into the coming year, especially with the emphasis on value-based care, outsourcing many of the billing tasks will free back-office staff from more routine billings tasks to interact more fully with patients.
  • The QPP Final Rule impacted MIPS reporting methods – physicians can choose to report via registry or EHR. Primary-care physicians may prefer using EHR as many common measures are contained within the systems, while specialists may find that a Registry offers more measures – and the chance to increase reporting scores.

A Look Ahead at 2019 

Below are several of the top challenges for the year ahead ranked by the HealthCare Executive Group (HCEG) as they pertain to medical billing and practice management strategies:

  • Data analytics also made the top spot for 2018, as the importance of leveraging data for improved medical outcomes and managing healthcare remains critical to the successful revenue cycle management for any organization or practice.
  • Population health services will continue to be focused on broader ranges of services offered: clinical integration, chronic care management and identifying barriers, such as social obstacles, to care access.
  • Digital healthcare, which is focused on improving medical, social, financial, and environmental well-being, rose from ranking fifth in 2018 to second place. 
  • Value-based payment transition as well as managing cost and improving care by targeting specific medical conditions will be on the radar for 2019.
  • Operational effectiveness will include identifying factors in efficient processes (with the creation of new business models when applicable), implementing leaner quality programs, revenue cycle management, inclusion of robotics and AI automation, and real or near-time sales transactions.

Managing Billing, Improving Patient Accessibility and Minimizing Risk in Your Practice’s Revenue Cycle

Many financial experts have defined risk areas as anything impeding an organization’s ability to achieve its goals such as regulatory compliance, patient care, strategic growth, operations and financial performance. According to a report from technology, accounting and consulting firm Crowe on risk-management areas for practices, their data shows that certain aspects of healthcare billing and collections functions will pose major risks for healthcare organizations of all kinds and sizes in 2019:

Medical Billing

Crowe found that inaccurate and incomplete billing resulting in denials, costly resubmitted claims as well as diminished reimbursement bring significant risks to the revenue cycle.

Thanks to the increasing complexity of medical claims as well as other time demands of providers and their billing staff, more organizations are turning to outside third-party vendors for billing claims.The latest figures show that the medical billing outsourcing market segment is projected to reach $16.9 million by 2021!

Outsourcing claims has become especially important for new providers, who may not have the time or money to hire or train competent billing staff, so using an experienced medical billing service can fill in the gaps and keep a young practice growing.

Remember is that providers are not relieved of the responsibility for overseeing a vendor’s performance in sending clean and timely claims as well as following up on denials.

Other trends to consider:

Patient Access to Care

Access functions, such as registration, scheduling and admission processes should be more carefully implemented by front-desk staff to minimize risks for billing and accounting issues, negative impacts on patient and provider satisfaction as well as lost revenues. 

It’s important to stress that all information collected at the time of each encounter needs to be accurate, complete and all insurance and coverage information verified to reduce the chances of unpleasant surprises of cost and patient liability after treatment has begun.

Charge Capture

Providers will need to pay closer attention to accuracy and completeness of charges billed, particularly when higher-cost procedures are involved as well as when implementing new technology.

Medical Coding  

Increased complexity of coding requirements by payers, including CMS, means that providers will need to be sure that medically-necessary documentation is provided to support the applicable codes, and that any third-party services utilized are regularly monitored.

Denial Management

As always, tracking, identifying and effectively managing denials is a critical part of the revenue cycle. However, industry experts caution that 2019 will require an even more more interdisciplinary approach to denial management among a practice’s departments in addition to the back office to keep the claims submission process running smoothly.

Work With a Professional Medical Billing Service Company

Partnering with an experienced claims billing and practice management service such as M-Scribe can help to improve accuracy and compliance of billed medical claims, while freeing your back-office staff for more effective patient interactions in the revenue collection process. Our claims management professionals can also guide you through the data analytics maze, advise you on effective marketing strategies and help ensure that you receive the value-based payments and reimbursements to which you’re entitled.

Contact M-Scribe at 770-666-0470 or by email to learn more about our services and how we can help you manage your revenue cycle while remaining compliant with all applicable regulations.

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