Revenue Cycle Management in Healthcare

The moderator set the stage by describing the changing landscape of healthcare, aimed at improving processes that affect various facets such as patient care, access to medical services, ongoing monitoring of patients’ health as well as other key areas like patient billing. While organizations attempt to reduce expenses, investments in digital remain strong to counter gaps in their healthcare systems. However many of them are grappling with challenges through their digital journey.

With downward pressure on investments and the implementation of Diagnosis Related Groups (DRG) in Dubai, challenges around RCM optimization are being felt amongst healthcare providers in the UAE. While traditional tasks of RCM such as eligibility, claims management, and denials, remain intact, automating these processes has taken center stage in the discussion around optimization. Automation will not only reduce costs to collect by utilizing machine learning, it will also provide tools for payors to ease resubmission claims. The latter was expounded upon by challenging the existing system that governs reimbursement: how does an organization use digital and data from various disparate systems that don’t speak to each other for a payor contracting purpose?

While insurance-led businesses are at the forefront of healthcare in the Gulf region, India is predominantly cash-led with a system that has faced many challenges around revenue cycle optimization. A panelist from one of the biggest healthcare providers in India presented a meta-level approach to the paradigm shift that the country is currently undergoing. While the government in India used to lay out certain schemes for a class of citizens that includes government employees and armed forces, most providers found themselves bound by this plan;  the government is currently finding new ways to expand its footprint to include other classes of citizens in order to deviate from the primarily cash-based transactions and create a common platform that will ultimately change pricing and the way it will be executed (one such scheme is Ayushman-Bharat-Yojana – this will provide free healthcare for close to 40% of the population in the country). Another innovation that is taking place is the adoption of a digital health ID scheme: the government has launched a digital health ID scheme where every citizen will have a digital health ID that he owns. Insurance companies, healthcare providers and other stakeholders will have limited access to the patient’s information. This not empowers the patient, it also brings about the dilemma that exists between privacy and the ability to provide healthcare. For example, people who are more willing to provide their data are getting access to healthcare while others who are less willing won’t experience the same. Nevertheless, given all the stakeholders involved, it will be interesting to see how these challenges will be superseded.