What This Covers
Ten shifts in revenue cycle work that are worth planning for this year: some technical, some regulatory, some about the people doing the work. Where a trend rests on a rule, the rule is linked. Where it is a direction of travel rather than a measured fact, it is described as one.
Trend 1: AI Moves Into Production Workflows
Machine learning is being applied to account prioritisation, denial prediction and the routing of work to the right person. What it does well, where it struggles, and how to evaluate a vendor's claim are covered in how AI is changing revenue cycle management.
Trend 2: Paying a Medical Bill Should Work Like Paying Any Other Bill
The design target is the way people already pay their other bills:
- On a phone, from a link, without calling during business hours
- With a digital wallet or a stored card
- Over time, through a plan or financing
- After a reminder by text or email, where they have agreed to receive one
What that means for statements, channels and support is covered in improving the patient payment experience.
Trend 3: Price Transparency Matures
Two federal requirements are now well established:
- Hospital price transparency. Since January 1, 2021, hospitals have had to publish a machine-readable file of their standard charges and a consumer-friendly list of shoppable services (CMS; 45 CFR part 180).
- Good faith estimates. For services scheduled or requested on or after January 1, 2022, providers and facilities must give uninsured and self-pay patients a good faith estimate of expected charges (45 CFR 149.610).
Where it is heading:
- Estimates generated inside scheduling and registration rather than as a separate task
- Out-of-pocket calculations at the point of care
- More consistent formats across providers
Trend 4: Automation of Routine Tasks
Workflow automation is taking over the repetitive, rules-driven work:
Commonly automated:
- Insurance eligibility verification
- Claim status inquiries
- Payment posting
- Statement generation
- Refund processing
- Account reconciliation
Measure the effect against your own baseline before and after: data-entry error rates, time to follow up on a claim, and time spent reworking denials.
Trend 5: Integrated Revenue Cycle Platforms
Point solutions are giving way to platforms that keep the whole cycle in one place:
Integration priorities:
- EHR and practice management connectivity
- A single patient financial record
- Unified reporting
- Consistent patient communication
- Centralised compliance controls
What integration buys:
- Less duplicate data entry
- Fewer hand-offs where information is lost
- Reporting that does not need reconciling across systems
- Faster staff training
ArkCloud RCM is built this way: claims go out as X12 837 transactions and 835 remittances are posted back against the claims they pay, in the same system rather than through a re-keyed file.
Trend 6: Telehealth Revenue Cycle Challenges
Virtual care creates its own billing work:
Ongoing challenges:
- Licensing and billing across state lines
- Payer policies that vary widely
- Patient confusion about cost-sharing
- Technology platform integration
- Documentation requirements
Responses:
- Payer-specific telehealth billing rules kept current
- State-specific workflow configuration
- Patient education on telehealth costs
- Virtual care built into the same workflow as in-person care
Trend 7: Value-Based Care Implications
Value-based payment models change what the revenue cycle has to track:
Key changes:
- Quality measures reported alongside claims
- Shared savings reconciliation
- Patient attribution
- Care coordination cost accounting
- Risk adjustment documentation
RCM adaptations:
- KPIs beyond the traditional ones
- Quality documentation workflows
- Population-level analytics
Trend 8: Workforce Change
The work revenue cycle staff do is shifting:
What is changing:
- Automation moving routine tasks off people's desks
- Competition for experienced staff
- New roles in data analysis and automation
Training focus areas:
- Technology proficiency
- Data analysis
- Patient communication
- Compliance knowledge
- Problem-solving
Trend 9: Regulation Keeps Getting More Specific
Recent federal rules have replaced general standards with specific ones:
- Debt collection. Regulation F, effective November 30, 2021, sets specific call-frequency presumptions, validation-notice content and electronic-communication rules for third-party debt collectors (CFPB). What it means for healthcare is in FDCPA compliance in healthcare collections.
- Price information. The hospital price transparency and good faith estimate rules in Trend 3.
State law adds to both, and varies by jurisdiction.
Compliance strategies:
- A named owner for tracking rule changes
- State-specific workflow configuration
- Regular policy reviews
- Proactive compliance auditing
Trend 10: Data Security
Security pressure on healthcare organizations drives investment:
Threats to plan for:
- Ransomware
- Phishing
- Breaches at third-party vendors
- Insider misuse
Security investments:
- Zero-trust architecture
- Endpoint protection
- Security awareness training
- Incident response planning
- Cyber insurance, and the controls insurers ask for
Preparing for the Year Ahead
Immediate priorities:
- Assess your technology stack against what you actually need
- Pick one automation or AI use case with a measurable baseline
- Review the patient payment experience end to end
- Check compliance programs against the current rule text
- Invest in your team's skills
Strategic considerations:
- Build versus buy for new capabilities
- Partnerships for payments and financing
- A data strategy for analytics and AI
- Change management for new technology
Conclusion
None of these trends is new this year. What has changed is how specific the rules have become and how much of the routine work software can now take on. The organizations that benefit will be the ones that measure their own baseline first, then change one thing at a time.
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Two of the trends above are covered in depth elsewhere: how AI is changing revenue cycle management, and what patients now expect when they pay.
