Another year has come and gone — and that means it’s time for predictions on the year ahead. While 2022 may have been a bumpy ride for the healthcare industry (to say the least), we’re setting our sights on the future.
We asked our in-house experts to look into their crystal ball and offer predictions on revenue cycle management trends for 2023. How can practice owners and managers prepare? Which Medicare updates should we watch closely? What can we expect in the world of insurance billing and reimbursements?
Here are three key revenue cycle management (RCM) themes and predictions for 2023:
Telehealth Will Remain Top-of-Mind
Nearly three years into the COVID-19 pandemic, we’re still talking about telehealth as one of the biggest trends in revenue cycle management. And it’s not likely to change. If you’re offering telehealth through your practice, keep an eye on the headlines in 2023.
The Centers for Medicare and Medicaid Services (CMS) added 54 new services to the Medicare Telehealth Service List for 2023. CMS added these services under a Category III basis for 2023.
Category III includes current procedural terminology (CPT) codes for new and emerging technologies. CMS temporarily places codes in this category to measure use and collect data before making them permanent. You’ll be able to submit claims for those Category III telehealth codes at least through December 31, 2023.
However, some telehealth codes are solely covered under the public health emergency (PHE). Once the PHE expires, you can only use these codes for 151 days after the expiration date. As of now, the PHE will expire on January 11, 2023. Keep your eyes peeled for headlines on whether the PHE will end or if Department of Health and Human Services Director Xavier Becerra will extend it.
Throughout 2023 you can still bill telehealth claims with the place of service (POS) as it would be if the appointment were in-person — just add the modifier “95” to the claim. Also, starting in January 2023, you will need to add the modifier “93” to all audio-only telehealth claims.
Practices May Need to Prep for a Possible Recession
Heading into 2023, most industries — not only healthcare — are bracing for a possible recession. Hospitals and health systems are already struggling to stay in the black.
We hope this isn’t a revenue cycle management trend we see in 2023. Nevertheless, we recommend building a strong financial footing at your private practice so you can weather any economic storm.
It’s crucial to have an air-tight revenue cycle if your specialty focuses on care and procedures considered elective. During a recession, patients may lose insurance and decide not to seek routine, non-emergency care. And without insurance or extra cash, certain health-related costs may not take top priority.
What can you do to keep up cash flow and maintain a strong revenue cycle? Our in-house RCM experts recommend these two critical steps:
Verify Insurance Before the Appointment
Insurance verification is the first and most important part of the healthcare RCM process. If you don’t have valid insurance information for a patient encounter, you can’t bill for that claim — that’s lost time and money for your practice.
Collect Payments Upfront
Surveys show that patients are more likely to return to a practice if they understand costs upfront. They’re also more likely to pay for services, which means fewer write-offs and collection costs for your practice. You can add payable patient estimates to your RCM process and find other ways to work upfront collections into your pre-appointment workflow.
Spend Less Time on Insurance Billing
Automation Will Play a Larger Role
With industry-wide staffing shortages and increasingly complex payer rules, artificial intelligence and automation will grow as one of the biggest healthcare revenue cycle management trends in 2023.
From a staffing standpoint, using intelligent RCM software can help alleviate billing and coding staffing shortages. These platforms can automate claim scrubbing and processing, helping fill gaps on your team or avoid billing burnout with overworked staff.
Automation also helps give administrative teams more time to spend on patient care, strengthening relationships that will translate into more growth and revenue for your practice.
And with payer rules growing more complex every year, the future of healthcare revenue cycle management will include software with automatic claim editing rules. These critical features will help your practice avoid claim rejections and denials that cost your practice time and money.
Revenue Cycle Management Trends: Take Steps to Stay Ahead of the Curve
If these revenue cycle management trends are any indication, 2023 will be another fascinating year in the healthcare industry. And although there may be some uncertainty ahead, there’s plenty that private practices can do to start the year on solid footing.
- Stay on top of industry trends and headlines, especially regarding the Medicare Telehealth Services List and other reimbursement changes.
- Create a strong revenue cycle and build up your bottom line with an accurate insurance verification process and upfront patient collections.
- Employ automation in your RCM to reduce costly errors, alleviate staffing shortages and burnout, and improve the patient experience.
As you look ahead to 2023, Gentem can support you in all these areas. Our team of revenue cycle pros and AI-powered RCM software will help you stay on top of payer trends and find opportunities to improve your reimbursement process. Learn more about Gentem today or book a call with our team.
