What’s Coming Down the Road for Healthcare RCM in 2024

2023 was an important transitional year for healthcare. The COVID-19 federal health emergency has ended, and along with it, government programs such as the Coronavirus Aid, Relief and Economic Security (CARES) Act, that helped mitigate the economic burden on hospitals and providers. 

What will 2024 hold for the healthcare revenue cycle? Hospital margins are on the rebound, but staffing shortages and rising labor costs persist, while denials continue to increase. All of these stresses impact the cost of collecting on patient and insurance accounts. Let’s take a deeper dive into these factors and what your hospital can do about them. 

Staffing and Labor Challenges

Staffing and labor shortages will continue to be a challenge due to insufficient academic pipelines for nurses and clinicians, job dissatisfaction, burnout and employees reprioritizing their needs post-COVID-19, as reported by Becker’s Hospital Review.¹ 

It is important to have strategies in place to address staffing and labor issues. Consider the following:

• Outsourcing Aged Accounts: Staffing shortages mean that accounts receivable often don’t get resolved in a timely manner. As those accounts age, they become less collectible over time. In one case study, Meduit partnered with one health center to work accounts at 120 days and beyond, realizing $17.5M in receivables for the organization. This cash helped ensure the center’s financial health and ability to deliver quality patient care.
• Leveraging AI: Artificial intelligence (AI) can be effectively utilized to help with labor shortages. Meduit’s Supervised Autonomous Revenue Associate (SARA) employes AI to accelerate cash while reducing cost and increasing efficiency. Since her launch, SARA has performed more than 2 million revenue cycle tasks and does the work of 150 FTEs. By doing the work faster and more accurately than human staff can, with no downtime and at a lower cost, existing staff has time to work on more complex issues to advance the revenue cycle and patient care. 

Rising Healthcare Costs and a Focus on The Patient Financial Experience 

U.S. healthcare costs show little signs of abating in 2024, and concerns about the affordability of medical services and medications continue to grow, according to a report from Business Group on Health.² 

Positive patient financial engagement helps drive patient financial satisfaction and a healthy revenue cycle. Having the right combination of self-service solutions, with their added convenience, and full-service patient solutions delivers the right balance that lowers the cost of patient engagement and collections while improving patient satisfaction. Consider these tips for deploying patient financial engagement solutions effectively.

• Offer self-service, technology-driven solutions that offer patients convenience, including:
  • Interaction through voicemail, text, email and online chat
  • Digital statements with QR codes that take the patient directly to their payment portal
  • Online payment options, including text to the client’s payment portal
• Provide full-service support for patients via a complete patient call center with live humans who can:
  • Talk with patients in real time
  • Review billing questions
  • Take payments
  • Offer patient financing alternatives 

Increase in Denials 

In the first three months of 2023, approximately one-third of inpatient and outpatient claims submitted by providers to commercial payers went unpaid for more than 90 days. Many were outright denied.³ 

Current payer practices combined with AI and computer algorithms are denying claims by the thousands every month. There are really only two options for starting to beat the payers at the denials game:

• Build AI in-house via your internal IT team and deploy it with your existing staff. Providers need to be using AI aggressively to automate billing, claims follow-up and the appeals process to increase the response times and throughput to match that of the payers, who have added significant utilization of AI over the past couple of years.
• Partner with an expert denials resolution vendor who is using similar automation and can add staff and automated throughput to increase your current capacity. 

Many healthcare provider teams simply do not have the internal staff or financial resources to build AI technologies internally, leaving partnering with the right vendor. Before selecting a denials management firm with significant AI automation capabilities, ask the following questions:

• What processes does the vendor employ to review and remit data, and determine and classify the nature of denials?
• What is the vendor’s track record for appealing and overturning denials?
• Can the vendor help institute process improvements for claim submissions that will reduce future denials? 

The right vendor should:

• Provide proper verbiage in a submitted claim so it is correct before it is submitted, reducing the likelihood of denials
• Manage the appeal process
• Deliver denial analytics and transparent reporting back to your system 

Meduit can help hospitals, health systems and physician groups overcome these challenges in the coming year. For more information, email us at: contactus@meduitrcm.com.

¹https://www.beckershospitalreview.com/2024-healthcare-workforce-trends-you-can-t-afford-to-ignore.html. Accessed 12.08.23.

²https://www.businessgrouphealth.org/en/newsroom/news%20and%20press%20releases/press%20releases/2024%20trends%20to%20watch. Accessed 12.08.23. 

³ https://www.aha.org/news/headline/2023-05-22-report-hospitals-struggle-collect-payments-commercial-insurers#:~:text=One%20in%20three%20inpatient%20claims%20submitted%20by%20providers,200%2C000%20physicians%20analyzed%20by%20Crowe%20Revenue%20Cycle%20Analytics. Accessed 12.08.23.