What Are Healthcare’s Most Pressing Revenue Integrity Issues in the Remote Work Era?

With more and more organizations merging for scale and sustainability, revenue cycle teams are being centralized, taking these critical personnel further away from physicians at the bedside. Remote teams are finding it harder than ever to collaborate with clinicians on critical functions. Simultaneously, more revenue cycle functions are being automated as robotic process automation and generative AI evolves. With fewer administrative personnel in general — and even fewer on-site with clinical teams — the days of doctors, nursing leaders, and revenue cycle managers discussing their shared concerns in person are fading into the sepia-toned past. One of the more costly issues is proper billing and reimbursement of patient status. Providers and payers must both be aligned on outpatient vs. inpatient status before payment can occur. Misclassifying an inpatient claim as an outpatient claim can result in revenue loss for the provider, for example, but both parties must have the critical documentation and decision support necessary to ensure the appropriate level of reimbursement.