Takeaways from HFMA 2024: Future of Healthcare Revenue Cycle Management

As a healthcare organisation committed to staying at the forefront of industry trends, we recently attended the Healthcare Financial Management Association (HFMA) annual conference in Las Vegas. This four-day event proved to be an invaluable experience, offering a wealth of knowledge through multiple breakout sessions and providing opportunities to engage with revenue cycle leaders and CFOs from various health systems. The conference shed light on the latest innovations in the healthcare industry and offered glimpses into its future trajectory. In this blog post, we'll share my key takeaways from HFMA 2024, focusing on the transformative role of AI in healthcare revenue cycle management.

1. Applications of GenAI in Healthcare RCM

Artificial Intelligence (AI) was undoubtedly the star of the show at HFMA 2024. The conference featured numerous breakout sessions that heavily emphasised how Generative AI (GenAI) is reshaping the revenue cycle.

GenAI, a subset of AI that generates new content based on vast training data, is revolutionising the healthcare revenue cycle. Recent advancements have elevated these models beyond simple word matching to understanding language nuances, grasping deeper human context, and engaging in critical thinking akin to humans. This leap in capability has opened up unprecedented possibilities, from predicting claim denials to providing intelligent insights for decision-making, streamlining processes across the board.

In medical coding, GenAI is proving particularly transformative. By learning from millions of historical records and understanding the context behind medical documentation, AI systems can suggest appropriate codes with high accuracy. They can interpret complex medical scenarios, apply ICD-10 or CPT coding guidelines like expert human coders, and even identify potential compliance issues. This not only accelerates the coding process but also improves billing speed, reduces claim denials due to coding errors, and ensures a more accurate representation of care provided, ultimately optimising reimbursement.

2. Big Health Systems Embracing GenAI via Third-party Vendors

At HFMA 2024, it was evident that larger health systems are enthusiastically embracing AI for revenue cycle management, recognising its potential to revolutionise their operations. However, these organisations are approaching AI adoption thoughtfully, understanding the complexities and critical nature of these solutions in handling sensitive healthcare data. This has led to a preference for trusted third-party vendors over in-house development as health systems seek reliable, secure, and compliant AI solutions. The trend underscores the importance of choosing technology partners with deep expertise in AI development and healthcare intricacies.

This shift presents an opportunity for RCM agencies to leverage their long-standing relationships and strengthen customer growth and retention by integrating AI into their offerings. By partnering with knowledgeable AI technology providers, RCM agencies can position themselves as invaluable allies to large health systems, offering robust, AI-powered solutions tailored to the specific needs of healthcare revenue cycle management. As the healthcare industry (traditionally cautious about new technologies) begins to recognise the financial benefits of AI, we can anticipate an acceleration in AI adoption across the sector, with RCM agencies playing a pivotal role in this transformation.

3. The Shift Towards Onshoring Medical Coding & Billing

An intriguing trend that emerged during the conference was the growing preference for onshoring in healthcare operations. This shift was highlighted in a particularly interesting session that discussed the pros and cons of onshoring versus offshoring.

The case of the University of California San Diego (UCSD) Health system was presented as a prime example of this trend. UCSD, along with other hospitals and health systems, has implemented a ban on offshoring due to mounting security concerns. This decision reflects a broader industry-wide reassessment of the risks associated with offshoring, particularly when it comes to handling sensitive patient data and financial information.

The move towards onshoring is driven by several factors:

• Data Security: With the increasing frequency and sophistication of cyberattacks, healthcare organisations are prioritizing data security more than ever. Onshoring allows for greater control over data handling practices and ensures compliance with local regulations.
• Quality Control: Onshore operations often allow for closer oversight and more consistent quality control, which is crucial in healthcare financial management.
• Regulatory Compliance: Healthcare is a highly regulated industry, and onshoring can simplify compliance with complex and evolving regulations like HIPAA.
• Cultural Alignment: Onshore teams may have a better understanding of local healthcare systems and cultural nuances, leading to improved communication and fewer errors.

While onshoring may come with higher costs, many healthcare organisations are finding that the benefits in terms of security, quality, and compliance outweigh the additional expense. This trend is likely to have significant implications for the healthcare RCM industry and is expected to further accelerate the adoption of technological advancements such as autonomous coding.

4. The Rising Challenge of Claims Denials

One of the most pressing issues highlighted at HFMA 2024 was the increasing prevalence of claims denials. This growing challenge is putting significant strain on healthcare providers' financial health and operational efficiency.

According to statistics shared at the conference, a staggering 15% of cases now face denials. The cost of working on these denials is substantial, averaging over $60 per case. Even more concerning is that 56% of these denials are eventually overturned, indicating a high rate of inappropriate initial denials.

Several factors are contributing to this rise in denials:

• Commercial Health Insurer Policies: Many attendees reported that their experiences with commercial insurers are worsening, with 78% of hospitals and health systems noting increased difficulties. Insurers are implementing more stringent policies and complex requirements, leading to higher denial rates.
• Overburdened Clinicians: The healthcare workforce, particularly clinicians, are under immense pressure. This can lead to documentation errors or omissions that result in claim denials.
• Incorrect Code Inputs: Despite advancements in medical coding, errors in code inputs by providers remain a significant issue, leading to denials.

The high rate of overturned denials (56%) presents both a challenge and an opportunity. While it indicates a problem with the initial claims process, it also suggests that there's significant potential for improvement. This is where AI can play a crucial role.

By leveraging AI in denial management, healthcare providers can potentially reduce the costs associated with working denials, improve their clean claim rates, and accelerate the revenue cycle. The $60 per case cost and the high overturn rate represent a clear opportunity for AI to demonstrate its value in healthcare financial management.

5. Medical Coding AI Gaining Traction

The growing interest in autonomous coding solutions was palpable at HFMA 2024. One of the most visible indicators of this trend was the significantly heavier traffic observed at booths showcasing AI-leveraged technologies compared to those still promoting manual RCM processes.

This heightened interest reflects a growing recognition among healthcare financial professionals of AI's potential to address many of the challenges facing the industry. AI-driven solutions are attracting attention for their ability to:

• Improve Coding Accuracy: By leveraging vast datasets and understanding complex medical contexts, AI can significantly reduce coding errors, ensuring more precise ICD-10-CM and CPT code assignments.
• Enhance Productivity: AI can process and code medical records at a much faster rate than human coders, dramatically increasing the volume of charts coded per day.
• Ensure Coding Compliance: AI systems can be updated in real-time with the latest coding guidelines and regulations, ensuring consistent compliance and reducing the risk of audits.
• Capture Lost Revenue: By identifying missed codes and highlighting documentation gaps, AI can help healthcare providers maximize their legitimate reimbursements.

The contrast in booth traffic between AI-leveraged and traditional RCM solutions suggests that healthcare providers are actively seeking innovative ways to streamline their revenue cycle processes. This trend is likely to accelerate the adoption of AI technologies in healthcare financial management in the coming years.

Conclusion: The Future of AI in Healthcare Revenue Cycle Management

It's clear that the healthcare industry stands at the cusp of a new era in financial management, with AI poised to play a pivotal role. As we look to the future, we envision a landscape where medical coders, billers, and revenue professionals work in tandem with AI systems, ushering in a new era of improved productivity, enhanced accuracy, and better financial outcomes for all stakeholders.

To achieve these transformative outcomes, it's critical to combine cutting-edge technological advancements with human expertise. At CombineHealth, this fusion of technology and human insight is both our vision and our mission. We are continuously working towards bringing the best of both worlds to deliver superior results to our clients.

If you're interested in learning more about our offerings and understanding how you can implement reliable autonomous coding at your organisation, we invite you to book a call with us. Our team of experts is ready to guide you through the process of leveraging AI to optimise your revenue cycle management.

The future of healthcare financial management is here, and it's powered by AI. If you're interested in knowing more about how these advancements will impact your business and how you can future-proof it, we're just a phone call away. Let's work together to navigate this exciting new era in healthcare finance.