The US healthcare industry is making a definite shift towards value-based care, where the quality of healthcare delivered to patients and the results achieved take center stage, marking a clear departure from the traditional fee-for-servicess approach.

The US healthcare industry utilizes Prior Authorization as a means of ensuring optimal and cost-effective use of medical services in accordance with the insurance coverage of each patient. As a rule, healthcare providers must reach out to and obtain approval from the respective insurance companies before they can deliver certain medical treatments or services to their patients.

Hospitals seeking to optimize their revenue cycle and improve their financial performance must start with a foundation of meaningful KPIs. Benchmarking and strategic metrics for each KPI are crucial aspects of implementing an effective transformation.

The brass-tack discussion at the Health Evolution Summit 2023, a gathering of industry leaders, recently delved into the topic of financial transformation in healthcare.

A typical healthcare provider in the United States is reliant on payors, such as insurance companies, to pay the medical bills of the patients who seek their care. Based on the services they deliver, they make their claims to the payor in prescribed format, requesting reimbursement in accordance with the coverage linked to the patient.

Clinical documentation improvement sounds like a silver bullet for effective revenue cycle management - an easy and straightforward solution for all RCM woes of healthcare providers - but it demands executive willpower, systemic transformation (in many cases) and most importantly, the cooperation of physicians, nurses, coders, and other healthcare personnel.

Providers may come across varying degrees of medical necessity denials on their reimbursement claims, based on the payers and the plans they work with.

Healthcare providers in the United States are now grappling with denial rates of up to 40% of their total reimbursements, according to American Medical Association.

Patient access services can improve the patient experience by providing clear information, streamlining registration and scheduling processes, and using technology to enhance communication and engagement. By addressing financial concerns and meeting the needs of diverse patient populations, patient satisfaction can be improved.

As we set out to write the trends for 2023, we see that operational efficiency is now the central theme for hospital and healthcare systems leaders. The trends we covered in our 2022 paper continue to get stronger. These included the dawn of the digital health era, the rise of telehealth, the shift to work-from-home models, surprise billing regulations, AI-enabled processing, rogue nation-states leading to increasing cybersecurity risks, and patients now responsible for a rising portion of payments. 2023 is likely to be a very different and fast-paced year and mark a definitive shift in how healthcare is delivered and paid.

An ineffective charge capture program leads to revenue leakage and delays cash realization. While most organizations focus well on back-office functions such as A/R and denial management, they fail to give due attention to the effectiveness of the charge capture process. Missed charges and inaccuracies in charge capture are the primary causes of ineffective charge capture.

A global pandemic forced rapid shifts in an institution that already had been a focal point of calls for change: health care. The panelists brought out perspectives on the impact of COVID-19, emerging technologies in healthcare, hospital finances, shift to value-based care, rise of wearable devices and interoperability.

Coming on the heels of the pandemic, an estimated 5 million US Workers have switched to new careers during the great resignation. The healthcare sector is one of the most affected, with the COVID-19 pandemic taking a toll on the frontline workers, i.e., physicians, nurses, and support personnel.

The post-pandemic path to recovery for hospitals and healthcare systems is steep with multiple challenges, including a severe shortage of clinical and revenue cycle labor, and unprecedented inflation. Initiatives such as value-based care, patient experience improvement, and process automation, on the other hand, are screaming for investments.

Increasing claim write-offs and decreasing success in denial appeals amplify the already sad state of the financials of hospitals and healthcare systems caused by the current labor shortage and trend of declining reimbursements. Shouldn't hospitals be focusing on denial prevention rather than denial recovery? Here are six tips to help you get ahead in the denials game and recover more revenue.

As hospital and health system CFOs prepare for the post-pandemic world, they are witnessing an unprecedented labor crisis and a spiraling backlog of A/R volumes that will bring down the entire organization. Cost pressures, shifts in payer mix, rising consumerism, and declining reimbursements add to their woes. Patient visits have been unpredictable in the post-pandemic world.

By outsourcing RCM processes, healthcare CFOs can unlock cash through cost savings and improved reimbursements. The improved effectiveness enables them to find the money to invest in technology and processes to deliver better patient care.

Technology and analytics are key enablers of revenue cycle transformation. It’s time for revenue cycle organizations to shift to data-driven decision-making and process automation.

You are considering making significant investments in revenue cycle process automation. However, almost 75% of the Bots fail when underlying processes change. Future-proof Robotic process automation requires careful engineering of the automation solutions. Micro-bots and Micro-services, the key elements of Access Healthcare's enterprise automation platform, echo, ensure that your automation solution is future-proof and helps you get impressive returns from your automation investments.

The health system revenue cycle is a multi-functional environment with a lot of nuance and many steps - it is no wonder things can become very complicated! There is room for error at every stage of the cycle. The opportunity for error begins even before the patient walks into the waiting room and doesn’t end until after the claim gets paid and settled.

In this article, we talk about tangible actions you can take today to make your revenue cycle even more exceptional.

As with any other strategic initiative, there is an expectation of a good return on revenue cycle process automation investments. Despite the undeniable benefits of automation, automating the revenue cycle in a complex organization is no small undertaking. Organizational challenges can slow down or impede progress altogether. You might not have the team you need or the budget. In any case, automation is becoming a necessity that all organizations will need to implement soon. We developed a guide to help you through the challenges and pave the way for successful revenue cycle automation.