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Revenue Cycle Management (RCM) models are gaining traction within the healthcare industry as it's extensively recognized for its ability to reduce management complexities. The space is changing, and the operations behind healthcare compensation is changing with it. Healthcare organizations are going through an unprecedented crisis for the duration of the pandemic, where entire service lines have closed down to focus completely on stopping the spread of a deadly virus. Meanwhile, healthcare agencies have been going through a virtual revolution. Organizations are focusing on streamlining the entire manual processes switch from paper records to electronic databases. Revenue Cycle Management is critical for healthcare to hold monetary viability and offer higher care to their patients. The providers are looking for a new reimbursement system, and revenue cycle management will help them achieve their goal.
What are some of the significant challenges and trends that have been impacting the Revenue Cycle Management space?
The pandemic had an evident and devastating impact on the healthcare system; many essential things impact revenue cycle management space. One is the public health emergency, but on the other side, organizations are filtering 1000 patients every single day, and they are not using the old mechanism of registration. But yet, CMS wants you to fill out a Medicare secondary payer questionnaire and make sure that all of the claim information is there so that they can pay you your measly. We have learned a lot during the pandemic about how to do more with less. The RCM space is transforming with new technological advancements, and we started to understand from a data perspective. Automation is driving the change in the healthcare space, and we are integrating our electronic health records. We are pushing harder on these electronic health record vendors to use artificial intelligence and use robotic process automation to reduce the task and boost the performance. So I think those are some of the things, in my opinion, that have become significant discussions and opportunities that we have in our revenue cycle space.
What to look for in a Revenue Cycle Management Partnership?
From a technology perspective, we are heavily investing in the right technologies. During the pandemic, we analyze what the technologies we need to automate our system are. In my organization, we were able to reduce our technology vendors because we had a lot of duplication. The most important aspect is understanding what you have, what you need, and those areas that we could utilize to automate our tasks. I used to think organizations should hire proven and experience vendors over new vendors, but I was proven wrong. Before selecting the right vendor for your organization, you should know what problems your organization is facing.
The vendor solution would be able to solve the difficulty faster and efficiently that will boost the organization's performance.
What are some of the common misconceptions when it comes to RCM in today's political situation?
The government wants healthcare systems, hospitals, and providers to be transparent. And so they are pressing all new rules and regulations to pull down the providers. The government is not willing to listen to the concerns of the vendors. Next year, they are introducing a new bill that says we can't bill for services that we can't control. The rules and regulations were framed 20 years ago, and we are simply following the guidelines. At first, the government needs to amend those guidelines in the context of modern healthcare requirements, but they are in no mood of changing those rules and regulations. They are trying to construct a wall between the providers and payers with such stringent rules and regulations that make it impossible for us to communicate. Unfortunately, in today's political landscape, patients are not aware or educated about the healthcare system's functioning, and they believe what the government or authorities convey to them. Politicians' unrealistic promises without consulting the medical experts put the healthcare industry under tremendous pressure to fulfill the people's expectations.
What would be the single piece of advice you could impart to your colleagues to excel in this space?
I would advise my co-workers to be curious and look at everything as an opportunity. With the adoption of AI and automation technology, the revenue cycle management space will change tremendously, embarking on next-generation youth chance to become part of RCM. For a long time, people working in the RCM industry have lost their innovative techniques to solve a problem. The spark is missing, but the next generation youth will look at the issues differently and uniquely address them with their fresh mindset.
What are some of the technological trends that excite you for the Revenue Cycle Management space's future?
Artificial Intelligence (AI) and automation can change the revenue cycle management, and medical leaders continue to believe that AI can yield high results. A survey conducted by Optum on AI in healthcare shows that 75 percent of healthcare leaders are looking to implement an AI strategy, with 43 percent saying automating the revenue cycle management process will be their first step. Experts believe AI will be beneficial as it maximizes the RCM system's workflow and understands the core challenges. It can optimize RCM by reducing medical claims errors and helping organizations update and change to avoid human mistakes and save the company from huge loss.