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Will 2019 Bring the new “Revenue Cycle Paradigm?”

March 11, 2019

According to the American Medical Group Association, physicians are hemorrhaging  profits, despite increases in gross revenues. Survey data showed that operating losses between 2016 and 2017 expanded from 10 percent of net revenue to 17.5 percent, even as gross revenues grew. The good news is that 2019 may be the year when an overdue revenue cycle paradigm shift occurs. That’s thanks to a confluence of factors including innovations in affordable revenue processing technology.

Price Transparency

Price transparency is a major accelerator of this expected shift. The new CMS rule that requires hospitals to disclose their standard fees for patients underscores the need for clarity. Patients have long complained that they cannot understand their bills, deductibles, and payment responsibilities. Even with the new CMS rule, most hospitals still post information that is too highly technical and is obscured behind confusing billing codes. The prices posted usually don’t even correspond to the real prices patients wind up paying. But providers who embrace greater transparency can strengthen their brands, attract and retain more patients, and avoid regulatory penalties and fines.

2019 Revenue Cycle Challenges

High-deductible insurance plans have also put an unexpected burden on patients, causing payment defaults throughout the nation. That is true regardless of whether or not states have expanded Medicaid support. Hospitals have also seen significant increases in expenses, both for operational overhead and the cost of payment collections. But an AMA survey revealed that healthcare providers spend nearly two days per week just filling out paperwork for prior authorizations from insurers. Making matters worse, the number of manual authorizations is increasing, at a time when technology can help to eliminate that slow, labor-intensive process.

Automated Solutions

Instead of taking days to confirm authorization, secure systems can automatically complete the process in as little as just a few minutes. Not only does that increase productivity and reduce provider overhead, but it also ensures a more satisfying and transparent patient experience and patient/doctor relationship. That is increasingly important since healthcare is making a huge move into value-based reimbursements. They are expected to account for 60 percent of payments by 2021, and providers need to focus as much attention as possible on the delivery of quality care.

Consumers are more actively involved than ever before in shopping for quality care at the best price. They expect greater flexibility and control over their care, and they are accustomed to a retail style of customer service that delivers convenience, security, easy access. One of the simplest ways to give them that is to redirect people and resources now devoted to front office paperwork.

Revenue-Capturing Technologies

Technology that automates payment processes and other labor-intensive tasks can free-up people and resources to focus on more personalized patient care. A secure platform can perform virtually instantaneous insurance eligibility and benefit confirmations. HIPAA and PCI-compliant online portals give patients 24/7 convenience for bill pay, access to medical records, prescription management, and more. They can even manage their own installment payment plans. That shortens the revenue cycle and minimizes the need for costly collections. Generating reports to verify value-based care is easier and faster, too, and cloud security offers protection and redundancy – but without cumbersome hard copy archives.

So while technology is expected to soon usher in a new revenue cycle paradigm, it will also bring with it many extra value-adding features and benefits.