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4 Ways Revenue Cycle Management Roles Have Changed

Revenue cycle management isn’t what it used to be. Without a doubt, coding, submitting clean claims and tackling denials are still very important. These days, however, it takes more than smart claims processing to succeed at revenue cycle management – you need to prepare for some major shifts in how it works.

As patients become payers and technology savvy becomes central to the revenue cycle, everyone’s roles are changing:

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Patients are Pushing Billing Technology Ahead

Your patients might not love paying bills, but if they must they want the process to be convenient. For example, one study found that 79% of patients surveyed were comfortable being billed by email. They also like mobile payments, paying via portal and using PayPal to settle up. Still, as of yet few practices offer all of these options, and some practices don’t offer any way to pay them electronically. While they’ve been happy to let providers choose technology in the past, consumers are now pushing them to get their act together.

Providers, Not Insurers, Need to Estimate Out-of-Pocket Costs

In the past, if patients wanted an estimate of their out-of-pocket costs for a service or procedure, they’d ask their health insurer what was covered and what wasn’t. Today, though, due to high deductibles and co-pays, they may be paying for everything, and that means providers have to provide cost estimates. In essence, their role has shifted from low-stakes participant to major healthcare payer, and that means their expectations have changed. The survey above also noted that 56% respondents plan to ask for costs of care estimates in the future and that 25% had already done so at their last medical visit.

Teams are Attacking Claims Problems

In the past, practice managers, coders, and clerks got together to attack claims submission and denial problems on their own. But no more. Today, RCM isn’t just a clerical function, it’s a multidisciplinary issue which calls for a variety of problem-solving techniques. It also calls for a team to supply that expertise. Depending on the size of your organization, that team could include chief financial officers, clinicians, and technology specialists — or any other staffer with the proper insights — in addition to the old standbys.

Insurers are Weighing in on Provider Technology

Historically, health insurers don’t take notice of what technology practices use, nor do they predict which type works best. However, they’ve become aware when clinicians use EMR templates to document care, they may copy and paste patient information from one patient encounter to another, and if that goes wrong, bill for services that particular patient didn’t receive. While health plans aren’t going so far as to recommend one EMR vendor or another, they’re taking a more active role in the discussion on appropriate EMR use.

The truth is that compared with other segments of the healthcare industry, RCM isn’t changing that quickly. But the changes that are happening are still a big deal. Patients are now taking the driver’s seat, new players are getting involved and payers (including Medicare) are keeping a watch on clinical technology. That’s certainly enough to keep you busy!