Due to problems brought on by shifting payer expectations and labor scarcity, hospital organizations are going towards revenue cycle outsourcing. This expanding tendency is highlighted in a recent KLAS report that compiles data from 61 general and specialty care clinics.
Recent changes in payer processes and criteria, according to the survey respondents, have increased their effort and caused confusion. Increased accounts receivable (A/R) days, greater rates of claim denials, and a significant amount of time spent on appeals and asking prayers for clarification on coverage rules are the results of this.
Grant organizations said payers raised standards for prior authorization requirements. They have implemented confusing referral processes. As a result, many of their previously authorized claims were denied. For the same reason, coverage limits were reduced.
Additionally, Medicare and Medicaid patients are increasing, which is good news for healthcare providers. This is wonderful news for patients’ access to treatment. But because of rising premiums, deductibles, and out-of-pocket maximums, reimbursement rates have decreased. Also, the number of accounts sent to collections has increased.
The enormous difficulty all of these developments have created for donor organizations to effectively manage funding processes. It led many of them to turn to revenue cycle manager providers for support.
Staffing shortages at payer and provider organizations are a further obstacle. Payer organizations’ inability to help providers with prior authorization modifications. Claims appeals are a result of a shortage of staff. However, shortages at provider organizations make it difficult to finish crucial activities.
According to the survey data, nearly two-thirds of participants chose revenue cycle outsourcing due to personnel issues. Provider organizations struggle to recruit and retain staff. It leads to high staff turnover and a lack of professional skills. While outsourcing has its costs, they are often less than the costs of hiring, training, and benefits.
Provider organizations are placing a high value on characteristics like accessibility, openness, and accuracy in their search for revenue cycle outsourcing partners. Additionally, respondents emphasized the need for promptness, knowledge, teamwork, and follow-up in developing a successful outsourcing partnership.
Some interviewees expressed concerns about the lack of a partner truly engaged in their success in the current outsourcing offering, and demanded more interviews and critiques.
Additionally, respondents want their suppliers to provide them with more thorough reporting. This monitoring includes specifics on their attempts to collect claims as well as measurable evidence of improvements in income. The necessity of ensuring a measurable return on investment (ROI) is what motivates this emphasis on reporting.
Interestingly, provider organizations seem to choose in-home support over outsourced services. Offshoring was highlighted as a factor that would affect nearly two-thirds of respondents choosing to work with or remain with a particular vendor. Similarly, 62% said beaches were also very negatively impacted.
Offshoring worries mostly center on possible problems with different operation hours, language hurdles, and misperceptions about domestic payer procedures. But precision, communication, and knowledge, could also apply to domestic help.
Revenue cycle outsourcing is widely used by healthcare providers. A report by CWH Advisors released in April 2023, showing that 61 percent of the providers in question intend to outsource revenue cycle fees in the next 24 months in 1999 further highlighted the growth in the sector.
Provider organizations are becoming more aware of the need for strategic modifications. Healthcare landscape is continuously changing to successfully navigate these challenging situations. They receive a crucial lifeline from revenue cycle outsourcing, which enables healthcare personnel to concentrate more on providing high-quality patient care while specialists handle complex financial elements.
It is also important to remember that the success of sales cycle outsourcing depends heavily on the technology and automation used. These improvements ensure that providers can maintain financial stability and compliance in an ever-evolving healthcare landscape. It helps streamline operations, reduce errors, and improve overall efficiency.
Intelligent use of technology and outsourcing are likely to be important factors in both the financial and health goals of healthcare organizations as they seek new ways to overcome staff shortages and payment status changing roles.