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How emerging
technology can
change healthcare
reimbursement
models and
methods

Author: Megan Williams

Healthcare reimbursement has always faced the need to evolve in line with technological advancements. From electronic health records (EHRs) to patient-facing tech, the medical billing, reimbursement and revenue cycle spaces have seen plenty of advances in technology. Even so, they've only scratched the surface.

Healthcare today is facing some very particular modern-day challenges—challenges that are shaping how emerging technology will impact the future of reimbursement. Healthcare leaders who take time to understand the current landscape and the potential of specific technologies in addressing challenges will be better prepared to step into the future of healthcare reimbursement and organizational financial health.

Understanding the challenges of the current healthcare reimbursement models

As healthcare has gotten more complex, specific needs have arisen in the reimbursement and revenue cycle spaces.

Supporting the patient financial experience

Healthcare professionals are paying more attention to the patient financial experience. This is in part because of increased awareness of the impact of financial issues on clinical outcomes (for example, financial toxicity) but also due to the rise of patient consumerization.

There is a thirst for technology that removes barriers, supports improved financial experiences for patients, and empowers providers to deliver a comprehensive care experience. Expect this drive to only become more pronounced as self-pay concerns grow—a Navigant-HFMA survey of revenue cycle trends found that "100% of large hospital executives predict moderate to significant consumer self-pay impact" on revenue cycle operations.

Connecting reimbursement methods with clinical workflows

At most organizations, clinical workflows are still largely siloed off from the revenue cycle and healthcare reimbursement. Revenue cycle workflows need to be better connected, especially to existing platforms like digital portals and telehealth. These are spaces where patient and clinician engagement are already high and existing tech solutions provide outlets of integration to bridge the clinical-financial gap.

Enabling reimbursement methods that move as fast as healthcare innovation

Healthcare reimbursement has seen quite a few recent changes—and will need the technology to keep up.

At the end of 2020, the Centers for Medicare & Medicaid Services released the annual Physician Fee Schedule final rule. The rule greatly expanded telehealth services to Medicare beneficiaries, opening the door to dozens of new services via telehealth. A total of 144 services were added, including emergency visits, discharge day management services and initial inpatient visits, pushing the need for technology that enables not only telehealth reimbursement but also value-based care and interoperability.

How emerging technology will impact the future of reimbursement models

Healthcare faces the potential for an end-to-end revolution of the reimbursement model—from the initial patient experience to back-end workflows and beyond.

The patient financial experience

From enabling price transparency to supporting data collection at the point of care, healthcare providers have a wealth of low-hanging opportunities1 to explore that will help influence how emerging technology will impact the future of reimbursement.

Artificial intelligence (AI) can support friendlier patient billing, provide insight into a more holistic patient journey and even support patient-facing tech like chatbots to improve the patient experience.

Enabling workflows

Reimbursement workflows and methods are the lifeblood of healthcare reimbursement, and technology stands to take them to a new level.

Again, AI can support workflow optimization by fixing broken processes and continually identifying areas of potential improvement. It can also be used to enable a more strategic use of human capital in the revenue cycle space by reducing the amount of manual support needed and helping organizations step into reimbursement functions they may have previously felt were out of reach.

Addressing new reimbursement challenges

Optical character recognition can be used to read the massive amounts of unstructured data in the healthcare reimbursement space (think patient checks and payor explanation of benefits statements) to reduce denials and support better navigation of the prior authorization and denials management processes.

More sophisticated data management and communications will also be critical to navigating precision reimbursement. For example, the expansion of telehealth services will require time-stamping, EHR integration and minute-by-minute tracking of screen time with providers ranging from physicians to behavioral health professionals. This will be key to streamlining reimbursement.

While considering how emerging technology will impact the future of reimbursement, some providers have already moved forward into a new era of healthcare administrative technology.

Learn how one provider leveraged Verizon technology to keep costs low and provide a modern telehealth experience through new network design, provisioned cell phones and cloud-connected audio.

1Beckers Hospital Review, New tech is sparking a revolution for the healthcare revenue cycle — 2 experts explain why, June 11, 2019, www.beckershospitalreview.com/healthcare-information-technology/new-tech-is-sparking-a-revolution-for-the-healthcare-revenue-cycle-2-experts-explain-why.html