2017 required healthcare organizations to respond to several new challenges – political change, growing role of technology, shift to value-based care and the increasing role of information security. While we anticipate that these issues will continue to influence through 2018, we will also see new challenges. The blurring lines between providers and payers, a refocusing on care (and more so on the patient), and a changing policy environment will occupy the center stage for 2018.

1. Top Revenue Cycle
Trends 2019

2. 2 | Top Revenue Cycle Trends 2019
Revenue cycle trends for 2019 and beyond
2018 was a very eventful year for the healthcare industry. The shift to value-based care, increased outsourcing and
offshoring by healthcare providers, increasing patient responsibility for cost of care, rising adoption of robotic process
automation, rapid evolution of artificial intelligence solutions custom built for revenue cycle, and most importantly,
increasing seamlessness in the flow of data between payers and providers, are some of the trends that will shape the
industry in 2019.
In 2019, decision makers in healthcare provider organizations will be challenged to keep pace with the rapidly
changing technology landscape and, accordingly, fundamentally redesign internal and outsourced processes.
In this brief, we will take a deeper look at these trends.

3. 3 | Top Revenue Cycle Trends 2019
1. Shifting physician concentration to larger entities
Imperatives for revenue cycle practitioners
Medical billing service providers need to assimilate the impact of
these changes and work with hospital/physician practice decision
makers to streamline increasingly complex revenue cycle
processes while training their staff members to understand the
implications and adapt to the changes in the processes.
Physicians are increasingly consolidating into larger physician groups,
hospitals, and health systems to achieve economies of scale, create a
stronger, branded healthcare experience, and to have improved access
to better technologies, all while leveraging better negotiating power
with health plans. As a result, the lines between inpatient and outpatient
revenue cycle processes and systems are blurring, which is further
compounded by the fact that provider organizations are now managed
by a single central billing office that now requires structured, revenue
cycle processes.
Typically, the fee schedules of the larger entity are adopted during
consolidation. More often than not, this leads to higher costs as health
systems tend to add components of facility costs on top of the typical
professional fee. Further, physicians operating in larger
organizations tend to see fewer patients each day as a result of
additional administrative work. The objective is for physicians to spend
more time on care with improved coordination of care. However, the
long-term impact of this will be increased cost of providiing care and
lower profitability.

4. 4 | Top Revenue Cycle Trends 2019
2. Improving the patient experience
Imperatives for revenue cycle practitioners
Medical billers need to recognize that every dollar that is not
collected at the point of service is a dollar that may be
potentially lost. Investing in better eligibility verification and prior
authorization automation tools not only improves patient
collections but also enhances the overall patient experience.
Consumer-Directed Health Plans (CDHPs) are becoming more
popular resulting in greater patient responsibility for the costs of
care. As a result, collecting patient deductibles upfront is becoming a
key to success. Further, value-based care is becoming a more viable
reimbursement model – replacing the traditional fee-for-service
model. With the overall patient experience in mind, healthcare needs
to adopt a point-of-sale (POS) retail model where the cost of care
and patient responsibility is communicated upfront.
Transparency. Patients want improved cost transparency to better
understand what their share of the cost is, as well as access to
convenient payment methods. Healthcare providers need to
accurately determine the cost of care, including all cost elements of
the billing cycle from pre-visit processes through settlement, and,
clearly communicate the out-of-pocket expenses owed by patients.
Customer Service Mindset. Effective training of the front-office
personnel to better understand the patient’s financial responsibility,
as well as, provide flexible payment options becomes critical to
delivering a positive patient experience.

5. 5 | Top Revenue Cycle Trends 2019
3. Digital healthcare and focus on total well-being
Imperatives for revenue cycle practitioners
While care providers need to invest in technologies that shift the delivery model
to more preventive mechanisms, service providers need to focus on including
care coordination, analytics-based preventive care, and improved utilization
of KPIs to maximize revenue recovery.
The use of wearable devices that facilitate continuous monitoring combined with an
increased application of analytics on population segments is on the rise. The total
well-being concepts that tie medical, emotional, financial, and social well-being are
more utilized in the delivery of care.
Connected healthcare technologies will potentially reduce costs, improve cost
transparency, and provide improved access to healthcare. Patients want to know
more about the healthcare conditions, get increased access to care when they want
it, and be able to pay for the cost of healthcare. Further increased awareness of the
costs of healthcare and increased focus on total well-being, is influencing people to
adopt more healthy lifestyles. New healthcare players including Amazon, Apple, and
Google, are utilizing ingenious mechanisms to get access to patient data and apply
the power of data and analytics.
While clear business models are yet to emerge in many of these areas, we believe
that digital healthcare delivery – in terms of analytics, information, and care delivery
– is here to stay. Health plans and care providers need to relook at newer ways to
stay connected with patients throughout the continuum of care. From information
dissemination about the health conditions to periodic monitoring and preventive
care, digital healthcare delivery models help reduce the total cost of care and
improve the overall experience.
As such, the changing nature of healthcare delivery is one of the key reasons
behind the consolidation in the industry – leading to larger brands with the technical
and financial strength to deliver healthcare efficiently.

6. 6 | Top Revenue Cycle Trends 2019
4.Consolidation and technology trends
Imperatives for revenue cycle practitioners
Revenue cycle practitioners need to become more judicious about
their technology investments. Investing in cloud-based platforms can
lower the total cost of ownership but the choice should be driven by
the investments that the solution provider is making into building
platforms of the future.
2018 has seen some of the largest multi-billion-dollar consolidation deals
including CVS-Aetna, Cigna-Express Scripts, and other moves such as
Amazon, Berkshire Hathaway, and JPMorgan Chase, creating a joint
venture to reduce healthcare costs. Further, the industry has also seen
multibillion-dollar investments by private equity companies (KKR
acquisition of Envision and Veritas Capital/Elliott Management acquisition
of Athenahealth) as well. Never before has the healthcare sector seen
such intensified levels of investment flows.
Looking at broader trends, some of the key reasons for the investment
flow into the provider technology space include
1) industry participants trying to own more components of the
healthcare value chain,
2) technology companies making investments to enable a more
connected healthcare system,
3) experiences from other industry verticals such as retail and financial
services being applied to the healthcare space, and
4) the need for increased cost transparency and mechanisms to
reduce costs.

7. 7 | Top Revenue Cycle Trends 2019
5. Revenue cycle platforms – strengthening cloud-based models
Imperatives for revenue cycle practitioners
Healthcare decision makers need to exercise the right level of
diligence while making investment choices on technologies.
The rate of change in healthcare technologies is taking on
increased proportions and, therefore, choosing the right
technology partner is critical.
The shift to cloud-based revenue cycle platforms will continue to
surge. While numerous platform players have begun to focus on
different specialty niches, we anticipate further consolidation of
platform players as the new connected ecosystem demands
increasing investments in analytics and more seamlessness
between inpatient and outpatient platforms. We see significant
consolidation of revenue cycle platform players with this increased
focus on consolidated inpatient and outpatient environments.
We also see a lot of focus on seamless information flows between
the technology environments – both financial as well as clinical
technologies – to enable the right care decisions and improving
the patient experience while reducing the cost of administrative
processes.

8. 8 | Top Revenue Cycle Trends 2019
6.The rise of value-based reimbursement models
Imperatives for revenue cycle practitioners
The new norm is to pay for increased value, greater efficiency,
more effective workflows, stronger care delivery, and improved
patient-physician collaboration that is driven by population health
analytics. As a result, revenue cycle decision makers have to
modify their delivery models to improve efficiency and
effectiveness.
The Affordable Care Act led to value-based reimbursement models,
which are now expected to surpass fee-for-service payments in the
next three years. An increasing number of healthcare institutions
– commercial insurance and health systems – are innovating and
developing newer models for value-based reimbursements. As per
Aetna’s 2018 Healthcare Trends report, over 59% of healthcare
payments will be value-based by 2021.

9. 9 | Top Revenue Cycle Trends 2019
7. Cost containment focus
Imperatives for revenue cycle practitioners
In order to keep pace with a reduction in reimbursement evidence
by value-based payment models, labor shortages and rising costs
of labor, a combination of automation, offshoring, and analytics-driven
cost containment strategies are likely to be adopted by healthcare
decision makers.
Cost containment focus takes center stage to address
1) high deductible plans/out of pocket costs
2) value-based reimbursement
3) increased regulatory compliance (i.e. ABN, MSP, MIPS, HIPAA,
Utilization Review/Case Management, and Site of Care Policies)
Healthcare executives are continuously looking for ways to reduce
costs – particularly labor – and increase profitability without sacrificing
patient care quality.

10. 10 | Top Revenue Cycle Trends 2019
8. Intelligent revenue cycle automation technologies
Imperatives for revenue cycle practitioners
Several automation platforms claim to automate significant portions of the revenue cycle process
chain. However, revenue cycle complexity is defined by its unique requirements – provider specific
business rules, multiple specialties, and non-standard processes on account of varying degrees of
automation across thousands of payers in the industry. Dealing with this complexity requires
1) a mature and efficient business process services team with capabilities to determine which
components of the process can be automated
2) a flexible, self-learning automation platform, and,
3) a seasoned team of revenue cycle process automation experts.
When trusting your revenue cycle services to outsourced or offshore service providers, healthcare
decision-makers should look at the automation capabilities of the service provider. As a best practice,
look at the flexibility of their solution in terms of man-machine interaction capabilities and the ability to
automate processes on-demand. Where possible, organizations need to look at a full cycle
operational effectiveness approach including workflow management, Lean Six Sigma quality programs
to identify transformation opportunities, a point solutions portfolio to rapidly customize automation to
newer processes, and provider-built automation solutions versus third-party automation solutions.
According to many industry analysts, about one-third of revenue cycle processes can be automated.
Revenue cycle processes are comprised of a high volume of business rules-driven repeatable
processes – a perfect business case for applying intelligent, robotic process automation
technologies.
The priorities for the revenue cycle have been shifting to the front office - improving the complex
prior authorization, eligibility, and benefits verification processes to determine patient responsibility
effectively. Such shifts have become increasingly important with high-deductible health plans. Further,
the back-office revenue cycle is seeing higher claim denial rates. Web-status automation and
intelligent analytics that can address denials effectively are technologies that will increasingly
become more utilized.

11. 11 | Top Revenue Cycle Trends 2019
Revenue Cycle Process Automation Solution
Patient Scheduling
Intelligent voice automation solutions working in synchrony with interactive voice response systems can automate as much as 30% of the
processes.
Eligibility and Benefits Verification Access insurance websites for eligibility verification and benefits determination through secure mechanisms with minimal human intervention.
Prior Authorization
Prior authorization requires a lot of paperwork from providers, resulting in increased time for payers to adjudicate prior authorization requests.
Through automated solutions, these requests can be submitted via payer websites, and in some case through EDI. Automated solutions can be
deployed for authorization and/or referrals, to ensure proper insurance coverage of the required procedures.
Patient Registration Optical character recognition (OCR) technologies combined with smart data entry.
Front office collections Self-pay solution to determine patient responsibility through machine learning and analytics.
Medical Coding
Optical character recognition, identification of medical procedure and diagnosis using industry frameworks for medical natural language
processing in patient charts, dynamic code suggestions using medical coding libraries.
Charge Capture and Entry Optical character recognition technologies along with bot-enabled smart data entry.
Billing/Scrubber/Clearinghouse edits Intelligent analytics combined with robotic process automation to verify the source data.
Claims submission to payers Dynamic construction of batches to submit claims to payers.
Payment posting (Manual) Optical character recognition technologies along with bot-enabled smart data entry (including rules-based reconciliation).
Payment posting (Electronic) EDI batch upload automation and combined with rules-based exception handling.
Secondary Claims Submission Optical character recognition technologies along with bot-enabled smart data entry.
Payment variance analysis Analytics to match receipts against fee schedules.
Accounts receivable follow-up
(by payer type)
Automation of pre-call analysis, intelligent web-status along with automated IVR interactions.
Claims Refiling/Appeals Machine learning based appeals letter generation, printing and faxing to create a near paperless environment.
Statements to patients Access by the practice management system to generate statements based on rules.
Denial posting and resolution
Optical character recognition technologies along with bot-enabled smart data entry Automation of pre-call analysis, intelligent web-status along
with automated IVR interactions, and refiling of claims.
Credit Balance and refunds, and Bad
Debts
Analytics on claim payments, automation of payment corrections and refund generation, adjustments, and the write-off of bad debts based on
business rules.
Reporting results and analysis KPI reports based on industry best practices (HFMA and MGMA standards, etc.).
Provider Enrollment and Credential-
ing
Initiation of provider enrollment processes, standardization of registration processes with payers, and generation of welcome letters.
Below is a summary of how automation technologies can be applied across the revenue cycle process continuum:

12. 12 | Top Revenue Cycle Trends 2019
9.Telemedicine is finally coming of age
Imperatives for revenue cycle practitioners
With over 49 million Americans enrolled, Medicare has
already released the telemedicine CPT code set online
which will further expand in 2019. Increasing adoption of
telemedicine by commercial payers to reduce costs will
further drive growth in this area. Consider making
telemedicine an integral part of your care delivery strategy
and backing it with a global delivery model for care
coordination.
With more than a quarter of the US population subscribing
to managed care plans, telemedicine is a key component of
value-based care. Today’s healthcare is increasingly being
provided by accountable care organizations and managed care
groups. Large employer groups/self-funded plans are utilizing
telemedicine to cut costs and expand access to providers, and
we anticipate that there will be increased adoption of
telemedicine trends. This trend is further fueled by the growth
of wearable devices and the ability to monitor chronic
conditions in real-time.

13. 13 | Top Revenue Cycle Trends 2019
10.Population health to improve the delivery and cost of care
Imperatives for revenue cycle practitioners
Embedding insights into point-of-service systems and equipping the
physicians and care coordinators can boost patient engagement and drive
effective follow through. Further, patients with chronic conditions need to be
educated on their conditions through an integrated, periodic digital
communication strategy supported by personal interventions.
Population health analytics can enable streamlined delivery of value-based
care, reduce costs, improve utilization of resources, and drive timely and
effective patient interventions.
Population health analytics enables caregivers to achieve the dual objective of
reducing healthcare costs while providing better care outcomes. The process
requires a three-stage approach
1) patient risk stratification to identify patients with high risk of negative
health outcomes
2) understanding the cost of care for these high-risk individuals, and
3) effective care coordination.
The transition from an understanding of healthcare data of patients to driving
effective care delivery is by no means an easy task and needs to be embedded
in patient-specific workflows.

14. 14 | Top Revenue Cycle Trends 2019
11. Utilize the power of analytics to improve the effectiveness of your revenue cycle
With reducing reimbursements, provider organizations are under pressure
to ensure their healthcare revenue cycle is operating at maximum efficiency.
While industry-standard KPIs, such as HFMA’s Measure, Apply, Perform (MAP)
Keys, and MGMA’s DataDive, provide effective mechanisms to assess
performance against industry benchmarks, the time has come to shift the
paradigm and integrate these insights into your operational workflow.
Imperatives for revenue cycle practitioners
Smart analytics engines capable of generating insights into how your
revenue cycle is performing in real-time and into your operational
workflow can dramatically help to improve your revenue cycle
performance. A combination of analytics technologies, artificial
intelligence, and a powerful business process management system can
focus the efforts of your revenue cycle team members on effectively
addressing issues such as A/R greater than 120 days, timely claims filing,
or credit balances. These technologies enable you to address your
revenue cycle issues proactively before they result in denied claims,
therefore maximizing significant value from your revenue cycle.

15. 15 | Top Revenue Cycle Trends 2019
12.Getting serious about cybersecurity
Imperatives for Revenue Cycle Decision Makers and Caregivers
Revenue cycle and healthcare technology practitioners need to take into account
the growing threat from hackers, business associates, and insiders. A strong
compliance program, as well as the adoption of secure information standards, is
required when dealing with business associates including offshore service
providers, and with employees. With end-to-end security no longer an option but a
requirement, it is critical to utilize partners who have a demonstrable track record of
operating in a compliant manner and adopting industry standards such as HITRUST
and ISO 27001.
A total of 4.4 million patient records were compromised in 117 health data breaches in
the third quarter of 2018, according to the latest Protenus Breach Barometer. As many
as 50% of these incidents were a result of hacking, followed by about 23% coming from
insider incidents. Protecting the privacy and security of consumer information to
maintain consumer trust in sharing data is critical to the success of the changing
business of healthcare. On one side, there is a need to allow a seamless flow of
information, on the other side, there is the growing number of information security
incidents to contend with.

16. Author
Manish Jain, Chief Marketing Officer Access Healthcare
Manish brings over 15 years of experience in solution design, sales, and marketing healthcare and financial services customers.
He can be reached at manish.jain@accesshealthcare.com
About Access Healthcare
Access Healthcare provides business process outsourcing and applications services, and robotic process automation tools to
healthcare providers, payers, and related service providers. We operate from 19 delivery centers in the US, India and the
Philippines, and our 11,000+ staff is committed to bringing revenue cycle excellence to our customers by leveraging technology,
emerging best practices, and global delivery. Based in Dallas, we support over 300,000 physicians, serve 80+ specialties,
process over $ 70 billion of A/R annually, and ascribe medical codes to over 30 million charts annually. To learn how Access
Healthcare can help your organization boost its financial performance, visit accesshealthcare.com or write to us at:
info@accesshealthcare.com
m: +1 844.533.1307
w: accesshealthcare.com
e: info@accesshealthcare.com