Profit margins are getting steadier, but health systems still face problems like not having enough staff and dealing with denials and prior authorization requests. As the new year comes closer, leaders in revenue should know about the latest trends like generative AI, big language models, and autonomous coding. They should also know the newest strategies to make things work better, cut costs, and make more money in the long run. These are the trends to keep an eye on:

2023 was a big year for healthcare. The COVID-19 emergency ended, which means some rules changed, and many people lost their health insurance because of Medicaid changes.

Even though hospitals are making more money now, there are still not enough staff, and hiring temporary workers costs a lot more, almost 258% more than before.

Rising healthcare costs and changes in insurance coverage can also impact medical billing practices. Medical billing outsourcing services have to navigate complex insurance policies, negotiate reimbursements, and address issues such as denied claims to ensure accurate and timely payments.

These problems have been around for a long time and aren’t getting any better. In the new year, health systems need to keep looking for new ways to solve them and stay financially healthy.

Trend #1: Generative AI and LLMs on the Rise

AI-powered automation is growing fast. Nearly 70% of healthcare providers are thinking about using generative AI, with about 60% planning to use it for the revenue cycle.

Despite the buzz, generative AI is still new. It will upgrade older automation methods like RPA. In the future, we’ll hear more about large language models (LLMs).

Now, what can organizations do?

80% of healthcare execs are spending more on IT and software. This is because of generative AI. Organizations need to get ready for this tech and use it in the revenue cycle.

When trying out this tech, health systems should focus on automation. It can cut down on admin work and make operations smoother. Leaders in healthcare say the top priorities for generative AI are things like charge capture, patient data analysis, and workflow automation.

Trend #2: More Denials

Denials have been a problem for a long time and are going up. A recent AKASA survey found that 50% of providers say their denial rates went up last year.

Among the top 3 reasons for initial payer denials, healthcare leaders mentioned:

What to do now

Fixing denials needs a lot of knowledge, so adding more staff isn’t the solution. Rev cycle leaders should start looking closely at their patient access practices, like eligibility, money clearance, and prior authorization processes. They need to make sure everything is checked well ahead of time before the appointment to stop denials from happening. Then, they should check those details again closer to the appointment — in case anything changes.

When denials happen, it’s important to make a plan to find and deal with denials by type. Or quickly deal with high-dollar, time-sensitive claims that offer the most chance.

Leaders should also start finding advanced automation solutions driven by AI and ML that can handle easy, repetitive tasks (like checking claim status) and also make complex tasks easier (like prior authorization). There are chances across the whole revenue cycle to use advanced automation to save providers time and effort. With automation, revenue cycle staff can work on more challenging claims that can bring in money for an organization.

The right automation can even help stop denials from happening at all.

Here are nine ways to deal with medical billing denials better.

Trend #3: Healthcare Costs Going Up

Healthcare costs in the United States keep going up, maybe by 7% next year. With high deductible plans, more patient cost-sharing, and overall care costs, people are finding it hard to pay for care and so are delaying or not getting care at all.

Not knowing how much healthcare costs also stops people from getting care. An AKASA survey found that 35% of Americans don’t get care because they’re not sure how much it costs, which can make health worse and costs higher. Plus, most don’t know about ways to pay, like payment plans or help from their providers.

Trend #4: Labor Costs and Staffing Problems

There aren’t enough staff, and it’s been a big problem for years and isn’t getting better. Nearly 60% of hospitals and health systems have 100 or more open jobs. And with work getting harder and taking more time, getting staff is getting harder too.

Even when you can hire and keep staff, it costs a lot more. Hospital labor costs are going up, which hurts how much it costs to run things.

Trend #5: Coding That’s More Automatic

Coding is one of the hardest, most time-consuming parts of the revenue cycle and often has mistakes and wastes time. Coding automation is a new tech that’s supposed to make things more accurate, reduce denials, and make claims faster. The industry is moving from computer-assisted coding (CAC) to autonomous coding. Most big health systems have a CAC, but new tech lets us look at and use autonomous coding more. It’s not fully autonomous yet, but we’re getting there.

The tech can also let coders work on harder tasks that need human knowledge, like checking charts and audits.

To Sum Up

Automation is the future of coding. Healthcare can’t keep up with how much there is to do, with hiring being tough. Organizations should start looking at different solutions, looking for ones that are built for revenue cycle tasks and have human coders working with them. Look at the more advanced options that get you as close to fully automatic as possible.