Topics including payer compliance and surprise billing will lead the way for revenue cycle leaders in 2023.
2022 was hardly easy for revenue cycle leaders—between declining operating revenue for health systems, payers squeezing even harder on denials, and a fundamental shift in the workforce—last year was complex, to say the least.
2023 won’t see much of a change, as these trends will still be headache-inducing for revenue cycle leaders.
From February 15 to 17, the members of the HealthLeaders Revenue Cycle Exchange will be meeting in Carlsbad, California, to talk strategy and find workarounds and solutions to the following six trends for 2023 in hopes of remedying the headaches.
There is a lot of confusion in the industry about what a commercial or managed care payer would want in order to approve a claim.
Much of this confusion comes from the timing of requirements to ensure reimbursement. The bottom line should be the same for all payers: The documentation must show a plan of care based on the working diagnosis and then progress to the goal of the plan and when the patient can expect to reach the goal. But what if payers frequently change requirements? How do revenue cycle leaders keep up?
During the event, we will talk about how revenue cycle leaders are handling payers that are increasingly more difficult to work with. Many leaders are finding that payers are pushing back on reimbursement, requesting more authorizations and medical records, and increasing denials.
Price transparency and surprise billing
The No Surprises Act, which became effective in 2021, requires hospitals to post the prices for their most common procedures as well as offer a patient-friendly tool to help shop for 300 common services.
The various nuances of the No Surprises Act are complicated. So what tools are revenue cycle leaders using? How are they using combined estimates and partnering with physician groups? How do they get estimated costs to patients at the time outlined?
Improving the patient financial experience
How patients are billed plays a large role in the overall patient financial experience and satisfaction. Because of this, revenue cycle leaders said that helping patients navigate the billing process is essential in creating a positive patient financial experience.
Paper statements work, but the digital age has pushed organizations into not only wanting to add in that digital billing experience, but they are needing to. Patients are now expecting both digital and automated options when it comes time to pay their bill.
On top of this, balances are getting larger, so how do revenue cycle leaders inform patients without scaring them off? How are they creating a seamless experience for the patient?
Leadership development and succession planning
Maintaining the revenue cycle operations of an organization comes with a unique set of challenges. Labor shortages have been plaguing the healthcare industry for years, forcing revenue cycle leaders to reevaluate the way they remedy staff burnout and responsibility. Part of dealing with labor shortages is having a solid staff development and succession plan.
How do revenue cycle leaders identify rising talent if you don’t interact with them in person? How do they guide and give opportunities for staff members to grow their career and get noticed?
Securing champions in your ring
Although the revenue cycle encompasses a large amount of a health systems' staff, we need to remember that everyone at the organization plays a role. Revenue cycle operations are the ultimate team sport and requires physician champions, IT support, compliance, and even legal teams to back everything you do.
How are revenue cycle leaders working with all entities across the organization to improve optimization?
Like most of healthcare, the revenue cycle workforce has changed dramatically within the last several years. An entire office floor that previously housed a revenue cycle department is now silent and desolate as most staff have been working remotely for years at this point.
While working remotely has been a success for most organizations and is now a permanent work model, measuring productivity has moved to the forefront of concerns since staff are no longer under physical, constant supervision.
How are revenue cycle leaders managing remote staff effectively, ensuring their work effort, and making sure management is staying on top of issues? Are you hiring outside higher-priced markets to save labor costs? How are you fostering networking, bonding, culture, and loyalty to minimize turnover?
Join us in February to talk through all of these questions and more.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
Join us February 15-17 in Carlsbad, CA, for the 2023 HealthLeaders Revenue Cycle Exchange. To inquire about attending a HealthLeaders Exchange event, email us at email@example.com. Space is limited so reach out immediately.
Amanda Norris is the Revenue Cycle Editor for HealthLeaders.
Revenue cycle leaders will be facing many of the same challenges this year as in 2022.
Leaders at the HealthLeaders Revenue Cycle Exchange will be meeting to talk strategy and find workarounds and solutions to six main trends for 2023.