Emerging Trends and Challenges in Healthcare Revenue Cycle Management

-

 


The future of healthcare revenue cycle management (RCM) is fueled by technological advancements, evolving patient care delivery models, and evolving payer dynamics. Industry leaders have the opportunity to explore innovative solutions that can drive efficiency, lower costs, and enhance revenue integrity. From the integration of artificial intelligence (AI) and data analytics to the rise of value-based care, the emerging trends provide exciting opportunities for healthcare organizations to embrace these developments and transform their revenue processes.

Emerging Trends in Healthcare RCM

  • Adoption of Automation and AI-Driven Solutions. Hospitals and health systems are embracing technologies ranging from robotic process automation (RPA) to more advanced solutions like autonomous coding and agentic AI. Automation can reduce administrative burdens while increasing accuracy and efficiency, particularly in areas such as prior authorization and claims management.
  • Emphasis on Ambulatory Care. Health systems are facing increasing pressure to meet patients where they are to improve patient access and satisfaction while managing costs. Outpatient care introduces unique challenges and revenue structures compared to hospital-based billing, requiring healthcare organizations to adapt their processes and technologies accordingly and invest strategically in tailored systems and workflows.

RCM Challenges Facing Healthcare Organizations

The top 4 Challenges are Rising Denial Rates, Underpayments, Workforce Issues, and Government Payers....

Read more at AGS Health’s Blog: Emerging Trends and Challenges in Healthcare Revenue Cycle Management

Comments

Post a Comment

Popular posts from this blog

Obstetrics Coding: Insights and Guidelines

-
Image
  Pregnancy-related  medical coding  presents its own unique set of challenges and nuances. Understanding the complexities of obstetrics coding for various complications and conditions affecting pregnancy, labor, and delivery is crucial for both facility and professional coders. Due to frequent updates in obstetrics coding, there are  Clinical Documentation Improvement (CDI)  opportunities to identify missed query opportunities and ensure physicians specify diagnoses with the greatest detail possible. Principal Diagnosis in Obstetrics Coding The principal diagnosis (PDX) in obstetrics coding is essential for accurate and effective coding, with direction provided in the  FY 2024 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Official Guidelines for Coding and Reporting.  The PDX instructions for pregnancy, childbirth, and the puerperium are located in Chapter 15. Complications of Labor and Delivery Labor and ...
Read more

High-Risk Medical Coding: Debridement Coding, Documentation Challenges, and Insights - AGS Health

-
Image
  To say debridement documentation is challenging is an understatement. It must be descriptive enough to create a clear picture of the procedure performed, a requisite level of detail that is tricky to attain because the procedure title and description within the operative note often do not correlate. Correct debridement documentation will include the following five elements, which provide the level of detail a medical coder needs to assign the appropriate debridement code: Wound, burn, or infection site. Depth of tissue being debrided Instrument used Removal of devitalized or necrotized tissue Mechanism of debridement Without specific and detailed documentation, coders will struggle to accurately determine the type of debridement performed, device used, and/or the tissue depth—all of which can impact reimbursement and compliance and contribute to the already high rate of claims denials related to wound care services. In fact, documentation issues are the culprit behind most denial...
Read more

Embracing Coding AI: A Strategic Vision for the future

-
Image
  The advancement of artificial intelligence (AI) is driving greater accuracy and efficiency in medical coding to maximize reimbursement. As healthcare organizations examine the path forward, it requires technology solutions that are inclusive and responsive to the needs of the continuum, from experienced health systems exploring autonomous coding to those new to AI-driven  clinical documentation improvement (CDI) ,  computer assisted coding (CAC) , and  computer assisted professional coding (CAPC)  solutions. Driving Advancement in Coding AI Successfully enhancing coding AI requires agility and adaptability. Framing technology advancements as a collection of “focus areas” rather than a rigid plan provides flexibility in addressing shifting customer priorities while still emphasizing emerging trends. Four key strategic areas of focus to drive advancement in medical coding AI include: Strategic Innovation.  Staying ahead of breakthroughs in generative AI and...
Read more