Many of today’s healthcare leaders would probably agree that 2023 has been a tough year. Hospitals and provider groups continued to struggle financially in the wake of the pandemic. However, looking ahead to 2024, there are new opportunities to improve medical coding, enhance medical billing, and promote a positive patient experience. The following are six healthcare trends to follow closely in the new year along with strategies to prepare your revenue cycle team and patient call center for the changes.
1. Higher healthcare costs.
Industry experts predict healthcare costs will increase by seven percent in 2024, further exacerbating the problem of declining profit margins for today’s healthcare providers. Physician groups will feel the ‘financial pinch’ because of the 3.4% payment cut that Medicare finalized for 2024.
What to do: Strive to contain labor costs while simultaneously focusing on revenue integrity new sources of revenue (e.g., community health integration, social determinants of health [SDOH] risk assessment, principal illness navigation, and caregiver training services). Reducing preventable hospital readmissions will also become increasingly important in 2024 as providers become even more cost conscious. Patient call centers may be able to help with this effort.
2. Ongoing healthcare staffing shortages.
Healthcare staffing shortages continue to negatively impact revenue cycle management and patient engagement, causing incomplete and erroneous claims. The result? Escalating denials and decreased patient collections.
What to do: Consider partnering with an outsource staffing vendor that can provide sustainable, cost-effective solutions or focus on developing a more robust recruitment and retention strategy. Don’t wait until January. Start now as the busy holiday season approaches. Keep this in mind: Staffing shortages aren’t going away any time soon. Proactive planning is key.
3. Continued exploration of generative artifical intelligence (AI) in healthcare.
Fifty percent of healthcare leaders are actively developing a generative AI strategy. What this ultimately looks like in the revenue cycle remains yet to be seen; however, use cases continue to increase rapidly. For example, many healthcare organizations already use generative AI for denial and appeal management as well as clinical documentation integrity. Others are experimenting with it for insurance verification, patient registration, preauthorization, utilization management, and more.
What to do: Prioritize change management and the idea that people and technology must work together to ensure success. With the use of generative AI comes the need to upskill revenue cycle and patient call center staff so these individuals can focus on higher-value, more complex tasks. In some cases, healthcare outsourcing may be a wiser and more cost-effective solution—particularly when the vendor leverages an international workforce.
4. Stricter price transparency requirements.
In its 2024 hospital outpatient payment system final rule, Medicare says it will require hospitals to post charge information using a more precise template starting July 1. Hospitals will also need to include expanded charge information such as billing and coding information, general descriptions of items and services, and more.
What to do: Prepare patient call centers for a potential uptick in patient questions. Although new price transparency requirements are meant to clear up the confusion, questions will inevitably increase for a period before they level out. Establishing and monitoring call center key performance metrics will be paramount.
5. Renewed focus on health equity.
Health equity continues to be a focus area for payers (particularly CMS that recently published its Framework for Health Equity 2022-2032), providers, and other entities within the healthcare ecosystem. In addition, in its 2024 inpatient hospital payment final rule, CMS announced a change to the severity designation of the three ICD-10-CM diagnosis codes for homelessness from non-complication or comorbidity (non-CC) to complication or comorbidity (CC).
What to do: Strive to capture Z codes through SDOH screenings. Revenue cycle staff may need additional training in this area, and patient call center staff must also be prepared to answer questions like ‘Why does my healthcare provider want to know this information?’ and ‘What will my healthcare provider do with the information?’
6. More emphasis on risk adjustment.
Medicaid redetermination will continue to unfold throughout 2024, and healthcare providers may see a shift in patients to Affordable Care Act marketplace plans. This means there will be a greater focus on risk adjustment.
What to do: Ensure medical coders and billers receive sufficient training in hierarchical condition category (HCC) coding and risk adjustment payment models to adequately capture patient risk and severity. It’s equally important to develop processes for concurrent and retrospective chart reviews as well as engaging patients with care gaps to schedule appointments.
Looking ahead
These are just a handful of healthcare trends hospitals and physician groups will encounter in 2024. The key is to prepare now whether it’s through training and preparing staff internally, partnering with an outsource vendor, or using some combination of the two. It’s possible to mitigate potential challenges, but providers must be proactive.
Founded in 1999, Global Healthcare Resource has been a leader in revenue cycle management solutions and proudly employs 6,000+ HIPAA compliant coders, billing professionals and patient call center agents. Global operates as an extension of your office to improve productivity and increase ROI.