Revenue cycle management (RCM) buzzwords like “price transparency” and “patient engagement” flood the healthcare industry. In theory, these strategies are very promising. But when providers work hard to keep their practices afloat, can these trends really improve their bottom line, and are they sustainable? 

From “going mobile” to patient-centered solutions, we break down the top RCM trends and reveal effective tools and tips for implementing these strategies, helping providers streamline operations, humanize the patient experience, and boost their bottom line.  

Forces Fueling RCM Pressures 

Reimbursement issues, inflation, and a workforce crunch threaten the longevity of today’s healthcare practice. When combined with patient financial constraints and growing healthcare costs, it’s evident that providers need to refine their RCM strategies now more than ever.  

Here are some of the top revenue cycle challenges facing providers and patients in healthcare: 

Providers 

• Staffing shortages – One report projects the national nursing turnover rate is as high as 23% and a vacancy rate of 16%. A shortage of qualified medical personnel places more administrative burdens on providers, hindering revenue cycle efficiency and patient care delivery. 
• Payment challenges – According to a survey, 78% of providers report struggling to collect even $1,000 from patients within 30 days. 
• Rising labor costs – Due to staff shortages, providers face increased labor costs, such as benefits and wages. A report found healthcare systems’ labor costs increased from $42.5 billion to $839 billion between 2021 and 2023. This accounts for nearly 60% of the average hospital’s expenses.  

Patients 

Providers are not the only ones suffering. Patients are also feeling the pinch.  

• Growing expenses – McKinsey projects soaring healthcare prices are becoming increasingly burdensome to patients. The average family paid around $8,000 to $12,000 in healthcare expenses in 2021.  
• Medical debt – Healthcare debt was reported by 41% of consumers, and women are 22% more likely to be unable to pay off a balance of $1,000, according to the previously cited report. 

Top Revenue Cycle Management Trends to Watch 

When reviewing the above financial hurdles and statistics, it’s no wonder providers are taking a targeted approach to optimizing reimbursement and avoiding revenue leakage. Below, we list the top revenue cycle management trends to track and strategic ways to implement these solutions – right now. 

Ambitious Value-Based Care 

Value-based care (VBC) models reward providers based on patient outcomes rather than treatment volume. One study reports the efficacy of VBC, with ACOs (accountable care organizations, including providers and hospitals) managing $1.66 billion in savings in 2021.  

But what does this mean for your practice? Here are a few concrete ways to implement VBC practices that will support a healthy RCM: 

Conduct ongoing coding training and audits. According to the Healthcare Financial Management Association (HFMA), providers must focus on key metrics to achieve optimal reimbursement under VBC. Since most of this data is in revenue cycle workflows, accuracy in coding and billing is vital.  

To achieve this accuracy, providers need to create a broad education program for the billing staff and conduct comprehensive audits:  

• According to HFMA, more than 100,000 payer requirement changes occurred from 2020 to 2022. Ongoing education and industry certification are essential for maintaining an optimal coding knowledge level for medical staff.  

• Regular coding audits can pinpoint issues before they become major problems. If your practice lacks experienced coders, using certified medical coders to audit CPT, ICD-10, or HCPCS codes can dramatically impact your practice’s revenue. 

Opt-in to incentives. Providers can opt into value-based purchasing initiatives, receiving bonuses for performing well. One way to do this is to adopt an electronic health record (EHR) platform that integrates the Merit-based Incentive Payment program, or MIPS Assist, which helps providers avoid negative payment penalties. 

Patient-Centered Payment and Communication Solutions 

One survey found that 61% percent of providers say online portals are their top method for increasing patient communication. Another report reveals that 37% of patients prefer to pay through an online portal, and 32% want to use a mobile app.  

The point of these stats? Providers need to meet patients where they are and use methods they prefer. Below are patient-centered payment and communication trends making impacts in RCM: 

• Patient portals offer access to billing information and payment options. Some integrated online patient portals allow providers to send statements from within the EMR platform. Patients can view statements, ask questions, and pay online using this feature, getting practices paid faster. 

• Digital payments and mobile apps provide convenient ways for patients to manage their healthcare finances. Digital payment systems already integrated with EHRs allow for smoother financial transactions.  

For example, the cloud-based platform DrChrono offers an integrated Payments solution where patients can pay online and on their mobile devices. Automated patient statements and payment acceptance through this tool simplify and streamline financial workflows. 

The Intersection of AI and RCM 

Healthcare thought leaders are urging providers to use artificial intelligence (AI) to speed patient access, reduce waste in their operations, and lower costs. Here’s how you can use this technology in your practice: 

Automating Billing Processes 

AI helps automate medical billing processes, eliminating multiple data entries and human errors and improving clean claim rates. For example, DrChrono’s medical billing software offers a Billing Profiles tool that sets up codes for a provider’s most common procedures to reduce data entry.  

Improving Patient Experience 

Patients often spend hours with voice response systems to resolve payment issues. High call volumes also require multiple staff members to handle billing questions. AI-powered tools like Chatbots solve these issues by decreasing resolution time and reducing the need for staff. This solution boosts customer satisfaction and lowers labor costs. 

Predict Denials and Streamline Charge Capture 

Practices need help understanding why medical claims are denied. AI can improve claim rates by analyzing vast amounts of RCM data, allowing providers to make necessary changes to increase revenue.  

For example, DrChronos offers an AI-powered Denials Analysis tool that demonstrates providers’ common denial reasons, the top codes getting denied (CPT, ICD-10, or HCPCS), and the insurance payers most frequently denying billing claims. AI in charge capture can also streamline the claims process. CollaborateMD practice management software has a Charge Capture tool that offers a single app for billing codes. This solution uses AI to quickly pinpoint common payment issues, such as missing or late charges, in your revenue cycle and areas that need improvement. 

Patient Responsibility – What it Really Means in RCM 

Patients today are bearing the brunt of healthcare costs, making it essential for practices to manage patient financial responsibility effectively. Key strategies in this process should include: 

• Transparency: Offer clear and upfront pricing to patients. Financial education tools can help patients understand their bills and financial obligations. For example, DrChronos offers a Good Faith Estimate feature, which provides self-pay patients with an estimated cost of their healthcare services before they are rendered. 

• Flexible payment plans: Provide options that cater to different financial situations. Lower-cost payment plans, such as electronic automated clearing house (ACH), make healthcare more affordable for patients.  

Outsourcing RCM 

Outsourcing RCM is becoming the new normal. One report projects that 61% of healthcare providers plan to outsource revenue cycle management tasks in the future. Why outsourcing? Providers want to avoid coding and billing penalties. Here’s how adopting outsourced medical billing services can help avoid revenue cycle issues: 

• Save money: Outsourcing eliminates the need for in-house staffing expenses like hiring, salaries, and benefits. 
• Expertise: These services offer specialized knowledge, improving RCM accuracy. 
• Reduce medical staff burden: Outsourcing reduces the burden of claim processing, billing, and collections. 

Analytics, Reporting, and Compliance 

Data analytics play a pivotal role in optimizing RCM. By leveraging advanced analytic tools, especially those fueled by AI, practices can: 

• Identify revenue opportunities and pinpoint areas where revenue can be increased. 
• Fortify HIPAA compliance by ensuring all patient data is handled securely and keeping staff updated on coding changes. 
• Monitor performance to measure success. 
• Use data to streamline processes and reduce bottlenecks.  

Adopting RCM Trends: A Beacon of Hope 

Staying ahead of revenue cycle management trends is essential for billing managers and providers looking to optimize their revenue cycles. By integrating AI, educating staff, leveraging analytics, and focusing on patient financial needs and care, practices can achieve more streamlined RCM processes, loyal patients, and sustainable financial stability.