Healthcare workers are in short supply across the United States. This has been caused by several reasons, like the effects of the pandemic, tired healthcare workers, and more people needing care. Data from the Medical Group Management Association (MGMA) shows that nearly 60% of hospitals have over 100 open jobs they cannot fill. Jobs like registered nurses (RNs), medical assistants (MAs), and licensed practical nurses (LPNs) now pay more\u2014about 20% more for RNs and over 22% more for LPNs in the last five years. This is to help bring in and keep workers. But paying more is not enough because nursing schools have fewer teachers and less money.<\/p>\n
The shortage is not only for clinical workers but also for people who do billing, coding, and other office jobs in healthcare. The Healthcare Financial Management Association (HFMA) says about 49% of hospital financial chiefs see a lack of office staff as a big problem. About 26% are thinking about hiring outside groups to help with the revenue cycle jobs. A survey from the Commonwealth Fund found that 70% of Federally Qualified Health Centers (FQHCs) are missing staff, which hurts how well they manage patient billing and payments.<\/p>\n
When there are not enough workers in revenue cycle jobs, it slows down money coming in, increases denied claims, and causes delays in collecting payments from patients. The revenue cycle includes many tasks like registering patients, getting approvals, coding, sending claims, handling denied claims, and collecting payments. Not enough staff slows processing, leads to more mistakes, and adds extra work.<\/p>\n
Claim denials have been growing. HFMA data shows that denied claims cost providers a lot. About 22% of healthcare leaders say they lose at least $500,000 each year, and 10% lose more than $2 million because of denials. Denials from Medicare Advantage plans have gone up by nearly 56%, and those related to patient revenue have increased by over 63%. Private insurance often denies about 15% of claims the first time they are sent. Mistakes in patient information, registration errors, missing proof for medical needs, and wrong coding cause these denials.<\/p>\n
Denied claims don\u2019t just reduce income; they also increase costs. Fixing denied claims costs providers an average of $47.77 for each Medicare Advantage denial and $63.76 for each commercial denial. These costs add up to almost $20 billion a year for the whole industry. When there are fewer workers, burnout and quitting become bigger problems. This causes more errors, longer times to collect money, and weaker financial health for healthcare companies.<\/p>\n
Staff shortages come with higher costs for running hospitals. Labor makes up 56% of total hospital spending, which is the biggest cost. The American Hospital Association (AHA) reports that nurse salaries have gone up 26.6% faster than inflation in the past four years to keep workers. At the same time, healthcare costs overall are expected to rise by 7% in 2024 because patients are sicker and supply problems continue.<\/p>\n
Hospitals are also hurt by low payment rates. Medicare pays hospitals just 83 cents for every dollar spent, causing over $100 billion in unpaid costs in 2023. Payments from Medicare Advantage have gone down while hospital stays get longer. Delays in moving patients to post-acute care facilities, because of approval rules, have doubled the length of stay for some Medicare Advantage patients. This adds to hospital crowding and costs.<\/p>\n
High labor costs and rising administrative expenses mean hospitals must find new ways to save money and keep revenue stable, especially as staff shortages continue. Healthcare leaders need to try new methods to work well with fewer resources.<\/p>\n
Healthcare groups with fewer revenue cycle workers should use many ideas together. These include using technology, making processes more consistent, and training workers to improve how they work and collect money.<\/p>\n
Outsourcing revenue cycle jobs is becoming more common, especially in community hospitals and Federally Qualified Health Centers that have many open positions. HFMA says outsourcing these jobs will grow by 16% through 2028. Groups that outsource billing can get experts who work better with claims and help collect money faster.<\/p>\n
Outsourced Comprehensive Business Office (CBO) services use technology combined with expert teams to reduce errors and speed up revenue cycle work. This helps fill staffing holes inside organizations and improves financial results.<\/p>\n
Before using new technology, organizations should make sure their current processes are clear and consistent. Impact Advisors warn that automating problems without fixing them first can make things worse.<\/p>\n
Having the same steps and rules across many locations helps during staff shortages. It makes it easier to move workers where they are needed and reduces confusion. Strong training and onboarding help new hires get up to speed even with high turnover, which keeps things running more smoothly.<\/p>\n
Healthcare groups should train current office workers to do more complex revenue cycle jobs and learn to use new tools. Upskilling helps use existing people better and reduces the need to hire outside staff.<\/p>\n
At the same time, new training programs for recent graduates can bring more young workers into revenue cycle jobs over time. Teaching staff about revenue rules, insurance policies, and AI tools helps them work better and make fewer mistakes.<\/p>\n
As patients now pay more out of their own pockets, healthcare providers need to give clear information about costs and payments. Digital payment portals, electronic bills, and cost estimation tools help patients pay on time. This lowers unpaid bills and speeds up money collection.<\/p>\n
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