Last year was an important transitional year for healthcare. The COVID-19 federal health emergency 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.
Though margins are on the rebound, staffing shortages and rising labor costs persist, while claim denials continue to increase at a double-digit pace. Escalating healthcare costs are fueling a need to improve the patient experience in order to drive collections. All of these stresses impact the cost of collecting on patient and insurance accounts. Let’s take a deeper look into the issues that we expect will dominate the industry this year.
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
Solutions that leverage artificial intelligence (AI) are proving to be a winning formula for alleviating staffing pressures, because AI tools work 24/7/365. Embracing AI applications for the revenue cycle will continue to be at the forefront this year.
Increase in Denials
Current payer policies, combined with their use of AI and computer algorithms, are denying claims by the thousands every month. Claim denial rates have increased more than 20% over the past five years, with average claim denial rates hitting 10% or more, according to the Journal of AHIMA.2
To win the denials game, providers can build AI in-house via their internal IT team and deploy it with existing staff, but most providers just don’t have the resources to build AI technologies from scratch. So, it’s critical to find the right partner that’s already invested the time, money and expertise into building effective platforms to help reduce denials.
Growing Healthcare Costs and the Patient Financial Experience
U.S. healthcare costs show little signs of abating in 2024,3 which will also continue to put financial pressure on patients and stress on the patient/provider relationship. Deploying positive patient financial engagement helps drive patient financial satisfaction and a healthy revenue cycle at the same time.
Purely digital patient engagement solutions have proven to the market that they don’t work as promised. The same goes for traditional solutions such as call centers, postal mail and bulk emailing that get drowned out by spam filters, caller ID, crowded mailboxes and general media noise. This is a pivotal and permanent change in healthcare-related collections that demands leading-edge strategies. Having the right combination of self-service solutions, with their added convenience, and full-service patient solutions achieves the right balance that lowers the cost of patient engagement and collections while improving patient satisfaction.
In this issue of Cycle Up, we tackle these top revenue cycle issues and more, including:
- Harnessing AI to drive the revenue cycle
- Mitigating rising claim denials
- Top tech-driven tools that are driving the RCM game
- Identifying and retrieving missed revenue
- The latest in compliance news
Meduit aims to provide our clients with the resources needed to drive financial health that supports excellence in patient care. I hope you find this issue of Cycle Up informative and helpful to your revenue cycle needs.
1https://www.beckershospitalreview.com/2024-healthcare-workforce-trends-you-can-t-afford-to-ignore.html. Accessed 1.20.24.
2Claims Denials: A Step-by-Step Approach to Resolution (ahima.org). Accessed 1.25.24.
3https://www.businessgrouphealth.org/en/newsroom/news%20and%20press%20releases/press%20releases/2024%20trends%20to%20watch. Accessed 1.20.24.