Future-Proofing Healthcare: Addressing RCM Pain Points with Strategic Outsourcing

The Patient Protection and Affordable Care Act (ACA) shook the healthcare world for good. It shifted the focus to a consumer-centric approach, with more insured patients and smaller balances. Calculating patient responsibility got trickier with out-of-pocket maximums and new plan designs. Plus, value-based payment models demand tighter integration of clinical and financial data.

The traditional RCM model focused on insurers is yesterday’s news: Robust RCM capabilities tailored to the new consumer-driven, retail healthcare industry is the way forward.

But merely upgrading your technology is not enough; as highlighted by Gartner reports, RCM itself needs a revamp. Doing it alone can be a headache—complex, time-consuming, and costly.

The transformation of healthcare RCM for the better comes with challenges.

• Rising patient expectations and competition: Communication clarity, transparency, billing processes, and denial management are changing. Understanding your patients’ preferences ensures better patient satisfaction.

Existing Challenge: Patient dissatisfaction is a revenue death knell—and the stats from Statistica don't lie: Only 19% are happy with their healthcare costs. A paltry 33% have easy access to electronic records (Accenture, 2021). And a jaw-dropping 84% say interminable wait times spoil their medical experience (Business Wire study).

The rising competition leaves room for patient loss and decreased referrals. In short, you must focus on "retail" revenue cycle measures like real-time adjudication and point-of-service collections, as patients feel more like consumers. 

• Growing and aging accounts receivable: More patients will have higher deductible plans, increasing patient balances after insurance that are more difficult to collect. On average, patients pay more than twice as slowly as commercial payers.

Existing challenge: How COVID-19 affected Healthcare RCM

The COVID-19 pandemic caused severe financial strains in the healthcare industry. Disruptions in elective procedures and staffing shortages significantly impacted revenue collection, straining the RCM teams by forcing them to quickly adapt to new digital billing protocols and chase down unpaid claims.

The mix of bad debt is shifting to balance after insurance accounts with a higher probability of collection.

• Lack of visibility into data and operational inefficiency: Hospital executives find the revenue cycle complex due to non-standardized definitions, siloed functions, and lags in measuring performance.

You must understand RCM performance at a deeper level than just cost-to-collect or days in accounts receivable. Decentralized, non-standardized, manual revenue cycle processes will not meet evolving challenges and increased efficiency needs.

Addressing  RCM Pain Points

Since the end of 2020, the healthcare industry has seen a steady increase in the number of workers leaving the field. Burnout was initially caused by the COVID-19 pandemic but continues to grow due to employee dissatisfaction. Staffing issues significantly impact revenue collection and the growth of the healthcare industry overall.

Automate, outsource, and streamline your RCM processes to enhance efficiency and financial stability strategically. Mckinsey surveys show that up to 40% of healthcare providers may consider outsourcing RCM, with projected cost reductions of up to 35% alongside improved operational efficiency.

1. Partner with revenue managers like Flatworld Solutions to enhance process efficiency, enable more charges, and accelerate payments.
2. Enable AI and automation for appointment scheduling, reminder generation, patient eligibility verification, up-front payment process confirmation, and near-immediate claims processing to streamline your business operations,
3. Track and follow up on claims and claim denials using high first-pass acceptance rates and flexible payment options to reduce your organization's financial burden.
4. Measure KPIs like total reimbursement collected, net collections ratio, time claims spent in accounts receivable, first-pass acceptance rate, and denial rate to track your overall performance.
5. Invest in a robust analytics tool to monitor these metrics and track your overall progress in optimizing the revenue cycle for bottom-line improvements.

Working with expert RCM outsourcing providers can keep you ahead of the race without increasing expenses.

It’s time to decide if you’re a part of this future-first group. Stay ahead of the competition—partner with a specialized RCM provider for better financial outcomes.

Download our RCM Industry Report for an in-depth look at the future of patient-centric RCM for clinics and physician practices.