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Revenue Cycle Management: Emerging Trends for the Health Information Professional

July 09, 2024

a remote control sitting on top of a table

In today's rapidly evolving healthcare landscape, effective revenue cycle management (RCM) is crucial. This post surveys key trends and insights for health information management (HIM) professionals.

  1. AI and Machine Learning in RCM: AI and ML are being used to predict claim denials, automate coding, enhance payment predictions, and streamline prior authorizations.

  2. Focus on Patient Financial Experience: With high-deductible plans, improving the patient financial experience is key. This includes transparent pricing, flexible payment plans, cost estimates, and mobile payments.

  3. Telehealth and Remote Patient Monitoring: The rise of telehealth requires adaptation to new coding and billing rules, integrating remote monitoring data, and ensuring compliance.

  4. Data Analytics and Performance Metrics: Data-driven decisions are essential. This involves implementing analytics platforms, KPI dashboards, predictive analytics, and benchmarking.

  5. Outsourcing and Vendor Management: Many organizations outsource RCM functions, using hybrid models and focusing on vendor performance.

  6. Automation and Robotic Process Automation (RPA): Automation streamlines claims, payments, eligibility verification, and prior authorizations.

  7. Regulatory Compliance and Price Transparency: HIM professionals must stay updated on requirements for publishing charges, providing estimates, and ensuring compliance with the no surprise billing regulations.

  8. Emphasis on Denials Prevention: Organizations are shifting to denials prevention using pre-bill claim scrubbers, clinical documentation improvement, and predictive analytics.

  9. Integration of Social Determinants of Health (SDOH): Recognizing SDOH's impact, RCM strategies incorporate SDOH data to improve risk models, financial assistance, and community health initiatives.

Effective RCM remains critical. HIM professionals play a vital role in navigating trends and optimizing financial performance while ensuring quality care. By staying informed, they can drive innovation and improvement.

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