Once upon a time, doctors would only be reimbursed if they knew their patients or if the treatment was successful. However, as society progressed and realized the importance of proper medical care, regulations and structure were incorporated into the healthcare industry. Decades later, with countless new technological innovations, the revenue cycle management (RCM) industry was born. Many occurrences over the past few years, such as the continued attempts to repeal the Affordable Care Act (ACA), several large-scale mergers and acquisitions (M&A), and President Trump ceasing the Federal Government from providing cost-sharing subsidies to participating insurers in the ACA marketplaces, have impacted, and will continue to affect, the RCM industry.
Previously, RCM vendors were merely seen as inconsequential to the healthcare cycle; however, as payments became more complex and higher in quantity, the two started to be seamlessly integrated together to maximize patient care and reimbursement. Healthcare subject matter expert Lyman Sornberger, CEO of Lyman Healthcare Solutions, LLC, stressed that “today, they are both essential parts of the process. No longer can the two be separated in order to achieve sufficiency in healthcare delivery.” Because consumerism remains supreme in the U.S. healthcare industry, RCM specialists can stand-out by supporting and enhancing provider operations from customer satisfaction, costs transparency, and user-friendly points-of-view, among other things, in order to position themselves as trusted and knowledgeable vendors in the industry. According to George Buck, president emeritus of Frost-Arnett Company, “at the end of the day, healthcare providers and systems want to partner with people that they can ultimately trust.”
Despite its growing importance throughout the United States and overall size – it was estimated at $30.3 billion in 2017 – it’s not even recognized as an official industry by the U.S. Census Bureau. Additionally, RCM opportunities vary between regions, as certain state and local laws may significantly impact insured rates and operational efficiencies, leading to more ways for RCM specialists to distinguish themselves.
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