As the pandemic rages, healthcare organizations are confronted with arrested cash flow and diminished revenues. Critical income from inpatient hospital stays and elective surgeries were indefinitely postponed to save bed capacity. The looming threats of COVID outbreaks and quarantines are putting added strain and uncertainty on revenue cycles.
Medical billing and medical coding requirements have evolved swiftly with the 2021 guidelines already in effect.
These turbulent uncharted waters are prompting Revenue Cycle and Financial leaders throughout healthcare to ask a critical question: How can we minimize the impact of destabilized financial operations and re-establish a sense of normalcy? Where is the port in the storm?
To keep the ship steady even in troubled waters, Revenue Cycle Managers must update and refocus their best practices on improving quality to achieve optimal reimbursements. In this critical period, providers cannot afford to leave billable revenue on the table.
ECLAT Health Solutions has laid out recommendations to help steer your RCM process in a more stable direction as you navigate an incredibly disruptive period.
1. Establish a solid revenue integrity program
Revenue integrity is essential to a healthcare organization’s financial health.
As the healthcare revenue cycle management enters a precarious phase due to complexities introduced by the pandemic, CFOs will have to realign their focus on revenue integrity teams. This is to ensure that their facility is implementing adequate processes to prevent revenue loss or delay and improve compliance, and most importantly, ensure that their organization is keeping up with evolving regulations and newly established codes. Coding and charge entry teams will have to be educated on new codes to prevent denials at all costs.
Clinical documentation improvement (CDI) staff will be instrumental in ensuring that healthcare providers are meeting new documentation standards pertaining to coding COVID-19 related illnesses and should be offered adequate education to be effective at their evolving role. Healthcare providers preparing for an inevitable slowdown in cash flow will best benefit from leveraging comprehensive documentation to take advantage of new reimbursement policies offered by payers.
2. Address staffing challenges
With COVID-19 leading to unexpected demands, staffing the best has become challenging across all RCM services functions. Healthcare providers found themselves in a bind juggling whether between furloughs or work-from-home transitions. Remote operations further exacerbate issues resulting from a lack of visibility and tracking. Rework volume has also increased significantly, adding pressure on RCM services staff to get to their pending and seemingly never-ending task lists. Not to mention, keeping up with newly introduced diagnostic codes for COVID-19 and all its procedures.
While automating workflows is a great way to streamline the delivery of work and reduce costs, healthcare organizations embarking on their remote working journeys will need to consider important business processes to continue employee productivity.
We recommend that healthcare providers do not limit themselves to in-house functions and consider implementing work from home strategies - both locally and globally. They can also enlist the support of managed RCM services and consider outsourcing specific functions to qualified global AHIMA and AAPC credentialed experts in order to maximize ROI and refocus their efforts on critical RCM services metrics. Hospitals, physician offices, Independent Practice Associations, and other healthcare providers would benefit from outsourcing medical coding and medical billing functions to address staffing challenges and maintain healthy revenue and compliance.
3. Leverage Virtual Care Programs whenever possible
An increasing number of patients are turning to virtual care as COVID-19 cases abound. With CMS declaring patient parity with office visits, and relaxing requirements for providers offering virtual services across state lines, this trend is only going to see an upward tick and can mean continued revenue generation. Healthcare providers must monitor the efficient flow of clinical documentation captured from virtual care platforms to provide as much specificity as possible to medical coding and billing systems. Medical Necessity is required to earn full reimbursement due for virtual care services. Introducing telehealth into primary care team workflows can also offer opportunities for revenue generation.
4. Prioritize financial reporting
Revenue cycle processes have always been crucial to determining the financial state of healthcare providers - the pandemic has further strengthened their role in ensuring business sustainability. Revenue cycle teams’ accurate reporting is going to be essential to facilitate data-driven decision-making by business leaders. These reports include weekly and daily shifts in A/R, bad debt performance, strategies to minimize operations costs (outsourcing or remote working), A/R stratification and projections, net revenue forecasts, and so on.
Both payers and healthcare providers have been impacted by the shortage of workers in the revenue cycle and claims management. In fact, most providers are struggling with pre-pandemic and current accounts receivable, with billing offices and back offices both strapped for the workforce. Here’s what you can do to better manage your A/R:
- If you currently have an in-house billing A/R workforce, consider enabling remote work and equipping your team with the tools and resources required to perform effectively.
- You may also consider enlisting the help of a global partner. In order to secure your organization, you can create and implement robust security mandates in your contracts. But as a whole, the global partnership has tremendous potential in not just amplifying your workforce, but also leaving you with enough time and resources to engage and maintain relationships with payers.
- With a reduced number of in-person patient visits, there is bound to be a dip in your receivables while navigating COVID-19. It’s critical to first focus and amplify your follow-up efforts on A/R that are usually reimbursed without issues. It’s also a great idea to stratify and clear up your A/R backlog and then delegate reimbursement efforts to be repeated by either your internal or global team.
Keeping the cash flow running smoothly is important in determining how quickly or effectively, you’ll be able to bounce back after the pandemic.
How revenue cycle leaders can pave the way forward for healthcare provider organizations
With the pandemic leaving healthcare providers vulnerable to undesirable budget shifts, revenue cycle leaders will need to explore outside of their comfort zone to address the new normal ahead.
Furthermore, when the pandemic ends, we can expect a lingering economic impact that healthcare organizations will have to grapple with. Now is the right time to focus on improving the efficiency of revenue cycle workflows, automating processes, improving reporting and tracking functions, and implementing strategic global initiatives with ECLAT. For more information on how we can help you with your current needs, feel free to contact us at 703-665-4499.
You may also be interested in exploring our full suite of RCM services which include: