Staffing shortage is a real issue in the U.S. healthcare industry. While staffing shortages of clinical staff, such as doctors and nurses may be front-burner issues, revenue cycle management also suffers from acute staffing challenges. The good news is that you can reduce your staffing needs and thrive despite RCM labor shortage by automating your RCM.
How bad is it? RCM staffing shortage statistics
We’ll look at some surveys and reports to understand the level of revenue cycle management staffing shortage.
- In 2022, PWC and Becker’s Hospital Review conducted a survey, and 83% of respondents were experiencing labor shortages across the revenue cycle. Also, 44% of respondents indicated their RCM staff was down 10%-20% below steady-state levels.
- R1 RCM 2022 report surveying over 200 CFOs and VPs of Revenue Cycle indicated that 90% are experiencing a labor shortage in their RCM department and 50% of their RCM roles are vacant.
- A 2023 CWH Advisors study found that 63% of providers were dealing with staffing shortages in their revenue cycle departments.
What’s causing the shortage of revenue cycle management workers?
RCM professionals manage the financial aspects of healthcare, which includes billing, coding, and payment collections. Pre-pandemic, the healthcare sector was already facing labor shortages, but the pandemic exacerbated it.
Here are some of the reasons there is a shortage of RCM professionals:
Increasing demand for healthcare
The growth in the healthcare industry needs to be matched with an increase in skilled professionals in various roles, including revenue cycle management. Because, as more people need medical services, the need for billing, payment collection, reimbursement, and other RCM duties increases. Currently, the demand for healthcare services has exceeded the supply of qualified RCM workers.
The aging population in the country has resulted in a greater need for healthcare services. A report by the United States Bureau shows that the median age has increased by 3.4 years from 2000 to 2022. The highest single-year gain of 0.3 years was in 2021, bringing the median age to 38.8 years in 2022.
How does this affect the demand for healthcare services? When people live longer, they will need healthcare for a longer period. Also, older people are associated with more chronic conditions, such as heart disease, diabetes, and arthritis, requiring more medical care. Generally, as more people need medical care, there is an increase in administrative tasks related to billing, coding, and insurance claims, which places an additional strain on the RCM workforce.
New technologies require workers to possess additional skills to adapt to the tools. And the healthcare industry has not been left out. New tools, such as electronic health records (EHRs) and automated billing systems, while they may streamline processes and increase efficiency, require RCM staff to have additional skills. Hospitals sometimes struggle to find, train, or retain skilled RCM workers.
Because there’s a massive RCM labor shortage, RCM workers in hospitals, healthcare systems, and physician practices are under intense stress. This may cause skilled RCM workers to transition to other roles, thereby worsening the staffing deficit. Recruiting and training new employees to replace outgoing staff can take time and may cause short-term or long-term shortages.
The impact of the RCM staffing shortage on healthcare
RCM professionals perform administrative tasks, such as scheduling, registration, coding, billing, and customer service. However, inefficiency in carrying out those tasks because of RCM labor shortage poses several operational challenges, which affect healthcare delivery.
An R1 RCM survey reveals some of these challenges:
Providing certain medical services or procedures is not a straightforward process. Healthcare providers may need to verify a patient's insurance coverage. In some cases, they must obtain pre-authorization from the insurance company. A shortage of RCM workers means patients may need to wait longer to be cleared to receive care. In the R1 RCM survey, 49% of the respondents said they face care delays due to insufficient capacity.
Patient billing error
RCM workers ensure accurate billing and coding, which are crucial for appropriate reimbursement. A shortage of RCM workers could increase the workload on the staff, which could increase errors. In the R1 RCM survey, 48% of the respondents mentioned that one of the challenges they face from RCM labor shortage is patient billing errors due to a lack of experienced staff for coding, claims, and reimbursement. Billing errors can cause delayed payment, denied claims, and possible legal issues from non-compliance.
Longer hold times for scheduling and customer service call
When an insufficient number of RCM staff are handling the existing workload, which includes scheduling appointments for patients and other customer care services, naturally, they won’t be able to respond as fast as patients would want, and that could result in a negative experience for many patients. In the R1 RCM report, 45% of the respondents said that RCM labor shortage led to long hold times for scheduling and customer service calls.
Cancellations and rescheduling
Patients rely on RCM workers to receive critical information, such as appointment reminders and rescheduling notifications. When your RCM staff are overworked, it limits their ability to communicate adequately with patients. Patients may miss their appointment simply because they didn’t receive the right information. In the R1 RCM report, 44% of respondents reported that RCM staffing shortage led to cancellations and reschedulings.
How RCM automation can allow you to do more with less at this juncture
With increasing healthcare demand and RCM staffing shortage, revenue cycle management automation can help your organization become more efficient while reducing your staffing needs in the following ways:
Reducing manual tasks with automation
There are several tasks in the revenue cycle management that you can automate.
- Eligibility requirement and patient verification: Verifying patients’ insurance eligibility and registration are important stages in your revenue cycle, and you can automate them. Automating these two tasks will reduce claim denials and improve cash flow.
- Denied claims reworking and appeals: Denied claims are a part of the revenue cycle, and even if the percentage is low, it can still be a large number. Sometimes, the labor cost of manually appealing denied claims outweighs the revenue your organization will receive in return. By automating the process, you can get them done faster at a low cost. Automation can even help you identify the errors leading to claim denial.
- Claims underpayment detection and appeals: you can automate this task and make it easier to notice and appeal underpayments.
- Payer contract analysis and reporting: Managing your payer contract and the terms to ensure you’re accurately reimbursed according to the terms of the contract manually is an arduous task. But, you can automate the process.
Streamlining decision making with automated analytics
In the past, making any decision on your RCM process was by guesswork or by manually gathering and analyzing data to discover trends and patterns. However, RCM automation can help your organization make smarter business decisions faster with automated analytics.
Automated analytics uses advanced technology, such as machine learning, natural language processing, and artificial intelligence, to give you insight into your business process. It can gather and organize data from various RCM sources, such as electronic health records (EHR), payer data, and billing systems, to provide an overview of your revenue cycle.
Automated analytics can give you real-time insights into RCM key performance indicators, such as denied claims rate, bad debt rate, and days in account receivables. So, you can quickly identify the exact issues in your RCM process and make data-driven decisions to improve them.
Expediting billing and collections
With RCM automation, you can receive payments quicker by automating several parts of the revenue cycle that affects your billing and collections.
- Real-time insurance eligibility verification: This will increase your clean claims rates and reduce your denied claims. Also, when you’re able to provide patients cost estimates of service promptly, it provides patients with a better experience and increases your collection.
- Automated claim submission: Instead of preparing and submitting claims manually, RCM automation can help you generate and submit claims electronically, which will help you submit claims faster with more accuracy.
- Collections: Automate your collections to reduce costs and improve customer satisfaction. Instead of sending paper bills, which is a time-consuming process, you can send billings and reminders electronically.
Automating compliance with regulations like the No Surprises Act
Complying with some of The No Surprises Act requirements like transparent billing can be an administrative hassle. However, RCM automation can make compliance a breeze. For instance, performing a good faith estimate manually is a labor-intensive and time-consuming process, but it is simple when you automate it. Also, automating your good faith estimates will increase patient satisfaction, billing accuracy, and revenue.
Hit your RCM targets without hiring more staff with MD Clarity
The current revenue cycle management staffing shortage is not likely going to change soon, and you cannot wish it away. Smart organizations have discovered how to remain efficient in their RCM even with the labor shortage, and that's what RCM automation allows you to do.
MD Clarity's robust tool allows you to automate your revenue cycle management, so you can boost your RCM workers’ efficiency, improve patient experience, and meet your revenue goals. Book a demo to see how MD Clarity can help your organization to be more efficient in your RCM.