Payment trends in the American healthcare industry have gone through several challenges and are yet
to hold solid ground to ensure that the RCM medical billing is steady. Analyzing the trends in
payment structures and considering the varied effects of the pandemic on the patients, the results
come out to be something that healthcare leaders must look at to take their next step forward.
Several patients, both insured and uninsured, have gone through painful payment processes when
admitted for a medical service.
On the provider’s side, there have been several difficulties retrieving the due payments due to the
low rate of success. At the same time, some providers have also faced problems implementing
different payment options. Overall, issues with the payment pattern have made RCM medical billing
unstable for several organizations. The healthcare leaders must know what these trends highlight
regarding the problems patients face to make the complete payment.
1.Surprise Billing Persistent:
The federal government implemented the No Surprises Act starting in January 2022 to ensure that
patients do not receive massive balance bills when opting for emergency care at an out-of-network
facility. The other purpose of the Act is also to build a healthy financial relationship between the
provider and the patient through transparent communication. However, surveys show that in 2021, 87%
of the patients claimed to receive surprise bills. If the healthcare systems are yet not prepared
for a balance billing workflow transition, these bills could negatively impact the RCM medical
billing.
2.Increase in Out-of-pocket Expenditure:
Healthcare plans are showing high co-payments and deductibles for the last few years, thus
increasing the out-of-pocket expenditure for the patients. Family premiums have seen the highest
increase in cost, with the cost of an average family premium being 47% more in 2021 than that in
2011. The increase in out-of-pocket healthcare expenditure being more significant than the inflation
rate or the moderate wage hike has negatively impacted the RCM medical billing.
3.Price Transparency:
While 90% of the patients want to know the entire cost breakup of their healthcare service upfront,
only around 20% of the patients understand what they owe. Interestingly, more than 90% of the
patients do not know that healthcare organizations are bound to share their price structure.
Moreover, more than 20% of the patients do not know how to understand their health plan. These
crucial statistics indicate that there is much room for transparent conversation between providers
and patients regarding their payment structures to ensure that RCM medical billing remains
uninterrupted.
4.Demand for Digital Payment Methods:
During the pandemic, the healthcare industry adopted several digital payment methods like self-pay
and virtual payment gateways. However, it seems like a more permanent method now that close to 75%
of patients prefer online payment of healthcare bills. Even close to three-fourths of the
millennials said they would consider changing their healthcare provider to expect a more
straightforward payment method. Healthcare organizations should incorporate digital payment methods
into their RCM medical billing workflow to ensure better cash flow.
5.Price Transparency Rule Compliance:
More than 80% of the hospitals are not compliant with at least one of the clauses of the
Price Transparency Rule. Only about one-fifth of the provider population thinks price transparency compliance to be a
priority. Price transparency gives the patient a comprehensive view of the dues in case of a medical
service well in advance. Thus it prepares them to pay timely for healthcare services, improving the
RCM medical billing outcome.
6.Manual Collections:
Surveys show that a large portion of the provider population, nearly 75%, rely on paper checks for
their collection process. They even use paper checks to issue patient refunds. Contrary to the
methods followed by most providers, a significant share of the patient population prefers digital
payment methods. By transitioning to a digital payment platform or other easily accessible payment
techniques, providers could better reach out to the consumers and improve their RCM medical billing
returns.
7.High Patient Balances:
About 44% of the providers said that they had to collect greater than usual amounts from the
consumers, and the collection frequency was also more. The providers admitted having difficulty
figuring out new ways to collect their dues from the patients. Interestingly, providers offering
more than one payment method collected more than the providers who offered only one.
8.Healthcare Costs to Rise:
According to the data of 90% of health insurance payer networks, healthcare costs will continue to
rise in the upcoming years. With the anticipation of a cost rise, about 50% of the
employers feel that the cost-sharing will continue to increase. It is a significant factor for RCM medical billing since the cash flow could suffer from more
significant out-of-pocket expenditure from the patients.
9.Reimbursement Rates:
Getting back reimbursements from the insurance companies was one of the top concerns for the
providers in 2021. Around 50% of the providers adapted to electronic payments with payers as they
felt these practices could be better suited to manage the current challenges in the payer-provider
ecosystem. An increase in digital payments could fast track the cash flow process in healthcare
organizations, thus improving the RCM medical billing workflow.
10.EFT with Fees:
While more providers switch to EFT for their transactions with the payer networks, only 1% of the
providers support EFT with a fee, while close to 87% of providers prefer EFT without fees over paper
checks. According to MGMA research, more than 17% of payers charge a fee for the EFT payments owing
to third-party vendors. Though the costs might have hindered the electronic payment system, the
ERA/EFT transactions grew by 102% during the period between 2018 to 2021.
These statistics are crucial indicators for the future development of RCM medical billing strategies
for healthcare organizations. Ensure you keep these business insights in mind before planning for
the next step of revenue cycle management.
We hope this article helped you understand how the different trends in healthcare payments could
affect your RCM medical billing. Please connect with us in the comment section below in case of any
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