The healthcare revenue cycle industry is notoriously complex, with new challenges arising year in and year out. To support revenue cycle leaders, we took a closer look at insights from the past few years and identified three key areas that we believe will be more important than ever in 2024. These areas - people, margins, and payers - will each present significant challenges that revenue cycle leaders will need to solve, and in the world of medical coding and billing, innovative technology such as autonomous medical coding may hold the key.
Learn more about Nym's autonomous medical coding engine
The majority of revenue cycle leaders believe the current staffing shortages will continue to impact their operations for the long term. With fewer staff and resources available to manage growing patient volumes, teams will likely find themselves faced with increased administrative burden, putting healthcare organizations at risk of staff burnout, backlogs, and revenue loss down the line.
Autonomous medical coding solutions, which leverage AI to automate the medical coding process, can support revenue cycle leaders by providing an accurate, efficient, and scalable solution to the current medical coder shortage. By fully automating a percentage of the medical coding volume, autonomous coding solutions such as Nym’s engine take the added administrative burden off of medical coders and enable healthcare organizations to handle increasing patient volumes with ease.
This sentiment was echoed at the recent KLAS Research RCM Summit, with attendees telling researchers that “...autonomous coding reduces administrative burden and increases coding efficiency, both of which are key as organizations face staffing shortages.”
A recent PwC report predicts that healthcare costs will increase by 7 percent in 2024, and if history tells us anything, this trend will likely apply to administrative costs as well, with the US spending $18 billion more on healthcare administrative tasks in 2022 than it did in 2021 (a whopping 43 percent increase).
The combination of increasing costs and thin margins will likely result in increased pressure on RCM staff to maximize revenue collection and minimize expenses. Since errors in medical coding often have a direct negative impact on revenue, emphasizing accurate medical coding will be one of the biggest priorities for revenue cycle leaders in 2024.
Revenue cycle leaders will also focus on improving coding speed in 2024. With high interest rates still a concern for healthcare providers, finding ways to increase coding speed can significantly accelerate the time from discharge to revenue collection and help providers avoid the financial consequences of delayed payments.
Autonomous medical coding solutions are often held to an accuracy threshold, ensuring that the assigned codes align with provider, payer, and regulatory guidelines. Nym’s medical coding engine, for example, maintains coding accuracy of over 95 percent, helping reduce denial rates and the associated lost revenue.
Autonomous coding solutions also code at a faster rate than human coders. Nym’s engine codes entire patient encounters in seconds compared to the minutes (sometimes up to 30 or more) it can take medical coders to manually code a single encounter. In this way, autonomous coding solutions significantly accelerate payment cycles and enable healthcare organizations and providers to get paid more quickly.
The number of external payer audits quadrupled in 2023, according to a recent report by MDaudit, and more than a quarter of healthcare organizations failed both their professional and facility billing audits. Driven by the shift to value-based care and payer initiatives to reign in overpayments, increased scrutiny from payers and the associated increase in audits will likely persist through 2024.
With RCM teams (which include auditing personnel) already short-staffed, managing such a dramatic increase in external audits will be challenging from an operational perspective.
The benefits of autonomous medical coding can extend beyond increased coding accuracy and accelerated payment cycles and into the realm of audit support.
Nym’s engine, for example, produces fully transparent audit trails for every encounter the engine autonomously codes. Each audit trail includes supporting documentation for every code assigned to a patient chart, links to specific industry guidelines referenced during code assignment, and many other components that help provide full transparency into the engine’s coding rationale.
For healthcare organizations, these audit trails provide unprecedented value when it comes to supporting internal audits, and perhaps more relevant in 2024, appealing external payer audits. Instead of allocating limited staff to parsing through old patient charts, RCM teams can quickly access the related audit trails and leverage them to support the appeal.
Learn more about how Nym’s audit trails can improve compliance and support RCM teams.
Powering automation in revenue cycle management.
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