As healthcare organizations navigate an increasingly complex financial landscape, protecting and optimizing the revenue cycle has become more critical than ever. Over the next five years, innovations in technology, data analytics, and patient engagement will play pivotal roles in helping providers improve reimbursement rates, reduce denials, and enhance the overall financial experience for patients.
Artificial intelligence and automated technologies are poised to revolutionize revenue cycle management in the coming years. These tools can assist with everything from clinical documentation and coding to denial management and claims processing.
"I think it's going to be a tremendous benefit," notes Stephen DelRossi, Chief Financial Officer at Northern Inyo Healthcare District. "With the assistance in note-taking from physicians and marrying that with available technologies, AI can make suggestions and learn what the appropriate codes should be."
However, Jennifer Lavoie, Director of Revenue Cycle Integrity at Rush University Medical Center, cautions that organizations need to carefully evaluate AI solutions. "It's important to understand if it's truly AI or just a good analytic engine," she explains. "AI requires foundational information and large datasets to be effective."
When implementing new technologies, Lavoie recommends involving IT departments early to assess integration capabilities, potential pitfalls, and security considerations. She also stresses the importance of ongoing monitoring: "Have people on your staff that keep their eye on the technology to make sure it's running as intended and delivering the expected ROI throughout the contract lifecycle."
Data analytics will be crucial for addressing workforce challenges and improving operational efficiency. However, many organizations struggle to effectively collect, integrate, and act on their data.
"A lot of times in the EHR, we can't put things together because they're coming out of different components," Lavoie notes. "You need to pull that data out, make it assimilable, and ensure it's meaningful and actionable."
To maximize the value of analytics, Lavoie recommends building teams that combine revenue cycle experience with data skills. "What I'm finding is a nice combination is having people with experience in revenue cycle who have that data-minded goal for their career, and then pulling them into that IT space. They can connect the dots between all of those areas."
DelRossi emphasizes the importance of cross-functional collaboration: "I've created a team that includes IT personnel as the foundation, along with accounting personnel and analysts to really understand from a financial, fiscal standpoint what the data means. Because when the data isn't actionable, we're just spinning our wheels."
As healthcare organizations increasingly rely on technology, the threat of cyberattacks looms large. Recent high-profile incidents have underscored the need for robust security measures.
"You have to educate staff on security," DelRossi stresses. "I worked for a healthcare organization where one person opened an email, and 17 facilities were down. Now, we dedicate two days a week for penetration testing to make sure we're not falling into any traps."
Lavoie adds that individual teams play a crucial role in maintaining security: "Passwords are huge. Make sure staff understand the industry, security protocols, and the importance of vigilance. All it takes is one click on a malicious email to open a portal to disaster."
Organizations should also have incident response plans in place. Lavoie recounts how her team had to quickly assess all connection points and cut ties with compromised systems during a recent security breach at a major healthcare technology vendor.
The pace of regulatory change in healthcare continues to accelerate, presenting challenges for revenue cycle teams. Proactive monitoring and rapid implementation of new rules are essential.
"It's important to have personnel that understand the regulations and can proactively take those changes that are coming out to get your systems, IT, EHR, and all ancillary pieces set up the day they hit," Lavoie advises. "You need to stay ahead of it because those changes will hit your denials if you're not prepared."
For smaller organizations with limited resources, DelRossi recommends leveraging third-party connections and professional associations: "We make use of about three different companies to help us stay ahead, plus we're members of four professional organizations that have advocates working in Washington and at the state level."
Effective patient communication plays a vital role in protecting revenue and enhancing the financial experience. Many patients struggle to understand their bills and insurance coverage, leading to frustration and potential payment delays.
"One of the biggest complaints we get from our billing cycle is patients didn't know about particular charges," DelRossi explains. "We're pushing to make sure we're communicating with our population. Part of our IT solution includes sending out detailed messages with links so patients can look at charts and understand what's going on with their care and bills."
Rush University Medical Center has taken a comprehensive approach to improving patient communication across the revenue cycle. Lavoie outlines several initiatives:
"We've recently formed a task force to look at how to make our bills friendlier to patients," Lavoie shares. "We're examining things like revenue code descriptions and how we can modify them to be more understandable."
As healthcare organizations prepare for the next five years, several key strategies emerge for protecting and optimizing the revenue cycle:
DelRossi emphasizes the importance of addressing current challenges: "Let's forget about the problem that's going to exist three years from now. What can we do over the next year or two to affect the patient's experience? Because at the end of the day, everything's about patient experience."
Lavoie concludes with a holistic perspective: "Looking ahead for the next five years, it's important to assess people, process, and technology, and how you're going to pull all three together to solve the issues you have today and the issues coming over the hill that you haven't seen yet."
By embracing these innovations and strategies, healthcare organizations can better protect their revenue cycles, improve financial performance, and ultimately deliver a better experience for the patients they serve.