Revenue Cycle in the Times of COVID-19 – Creating a Sustainable Financial Future
COVID-19 updates by the regulators are across the news today. With many physician practices choosing to operate remotely, and reduced patient visits to the outpatient department, the financial health of healthcare providers is now reeling under the shock of COVID-19. The revenue cycle processes are also operating at a sub-optimal level.
MBW brings you some of the areas that financial administrators working at healthcare provider entities must focus on to stabilize financial operations and restore normalcy.
Optimizing reimbursements
Coding and billing requirements are changing frequently. Elective procedures are seeing a dramatic reduction in numbers. With changing guidelines on the revenue cycle processes, improving reimbursements should become the number 1 priority for revenue cycle decision-makers. Here are some strategies:
Coding for Telehealth and COVID-19 Inpatient Care.
With outpatient care increasingly being delivered via telehealth and the several new guidelines for coding and billing being issued by Medicare and other payers need to be implemented quickly and adhered to. Please see: New HIPAA Waivers Relax Telehealth Restrictions to allow care continuity during COVID-19 Emergency
Keep your chargemaster updated.
Payers are changing the norms for the component they will be reimbursing and lower patient liability and hence chargemasters of healthcare providers have to be updated. The billing staff has to be quickly trained on the service as well.
Follow Payer Updates
Payers are requiring that the right coding guidelines, usage of modifiers, and place/date of service be provided. Your revenue cycle team should adhere to these guidelines. Here are some best practices.
Follow the updates on Payer Website
Schedule a discussion with contracted payers
Keep track of denials and identify the source of the denial to make due changes to your revenue cycle processes
Managing your A/R
Both Payers and Providers have been impacted by a critical shortage of revenue cycle and claims management workers. With Central Billing Offices and Payer back-offices operating at a sub-optimal level, both your pre-pandemic and current A/R have been impacted. Here are strategies to deal with them.
Re-vitalize your billing office.
If you have an in-house A/R workforce, try to find ways to enable them to work remotely or with minimal staffing at your billing office.
Consider utilizing an offshore partner.
o Many of offshore providers have started working. With tighter information security elements in your contracts, you will be able to augment your workforce significantly with offshore partners and focus on maintaining relationships with payers.
A/R Stratification.
Remember that you are likely to see a dip in the receivables during the COVID-19 period due to the reduced number of patient visits.
Identify A/R that is typically reimbursed without any issues and increase follow-up effort on those claims.
Clear your backlog. Like all healthcare organizations, you have a backlog of A/R. With a reduction in new A/R on account of reduced patient visits, stratify the old A/R and focus on utilizing your internal and outsourced team to get reimbursed.
Remember that cash is king. The more you make out of your revenue cycle today, the better your chances of springing back into health in the post-pandemic phase, which will require renewed investments in brand building and patient visit improvement.
Another strategy you can deploy is to identify Payers that are not operating their back offices efficiently at this time. Discuss alternate strategies with them and classify this A/R for future follow-up. Document your discussions with the payer and put it on record – This will help you accelerate reimbursements in the post-COVID phase.
Deal with Patients with Empathy
As the economic impact of COVID-19 is significant, many patients are experiencing financial difficulties. Patients checking in are probably in need of critical care services and it is imperative that as a healthcare provider you can identify the impact of payer-specific guidelines on the self-pay/patient responsibilities for payment for care.
Deal with each case with care, empathy, and an accurate understanding of their financial commitments
Develop patient-specific payment options and also suggest the path of the least financial impact, including where possible, telehealth, and other options to improve the patient experience..
Facilitate Team Work and Remote Working
Revenue Cycle is a Team Sport. How your team works together across front-end, coding, charge capture, and post-submission A/R and denial management processes, eventually determine your financial health.
In the current state, most healthcare organizations have started operating revenue cycle operations through a remote work setting i.e. the Work from Home Model. Here are some pointers to help you optimize team collaboration and achieve maximum reimbursement.
Equip your workforce. Equip your workforce with the right tools – computers, connectivity, information security software, and video/audio calling and conferencing software.
Choose the functions that remain onsite. Other than mail, most revenue cycle processes can be performed remotely. Improve the adoption of ERA and payer portals. If you are not scanning documents already, this is a good time to transition to digital processes.
Team Collaboration and Productivity tracking
Team collaboration is key to your financial success. Keep your staff connected and improve your recognition and rewards programs.
Schedule calls the beginning of shift and end of shift to keep everyone engaged and informed about the changes
Track staff productivity through workflow automation.
Financial Reporting
The impact the revenue cycle processes have on the financial sustainability of healthcare providers, in these times of the pandemic and after, is very significant. In many healthcare organizations, the revenue cycle teams report to the CFO. Accurate financial reporting by the RCM function will help CFOs make informed decisions. Below are some of the reports that will help derive strategic decision making:
Weekly shifts in A/R
Bad debt performance
Payer specific operational realities and expected reimbursement dates
Projections for A/R and impact on net revenue
Strategies to reduce total cost of operations – outsourcing or shift to remote working
Conclusion
This is the time for revenue cycle leaders to take charge.
Revenue cycle leaders have an increased responsibility to ensure the financial sustainability of healthcare provider organizations. The Pandemic arrived without any warning. Healthcare providers and payers created an initial response to continue operating and as fresh guidelines were issued by CMS and healthcare payers, there were changes made to clinical and revenue cycle operations. While many of us believe that the worst of the Pandemic is over, the economic impact of this crisis is far from over.
This is also the time for revenue cycle leaders to help create a sustainable financial future for your healthcare provider organization. Focusing on creating more efficient revenue cycle workflows and tracking processes, adoption of strategies for process automation and strategic outsourcing, driving changes in policies and procedures, and managing your revenue cycle by the numbers is key to getting optimal results from your revenue cycle.
Talk to MBW today to discuss how our revenue cycle experts can help you through COVID-19 and beyond. Please fill the form below and we will be in touch.
