How healthcare professionals can navigate new challenges while trying to maintain revenue cycle health in uncertain times.
July 1, 2020
Responding to the pandemic extends beyond the front-lines into the healthcare revenue cycle. Across the country, revenue cycle teams are facing new changes related to COVID-19. These common challenges are impacting the future for many healthcare organizations.
New Challenges for Revenue Cycles
Canceled or Rescheduled Elective Procedures
Healthcare organizations (HCOs) rely heavily on elective procedures as they are typically the most profitable. Whether you've intentionally canceled electives or fewer patients have scheduled them out of concern over COVID-19, this revenue loss has hit HCOs hard.
As overhead increases in response to COVID-19, no one knows for sure how they will get reimbursed, how much, or when. HCOs are essentially borrowing from an uncertain future to fund the current day.
Record High Unemployment
For most states, unemployment is the highest its ever been. People losing company-sponsored health plans at record rates now means there is a massive surge of self-pay patients, and the ramifications don't stop here. Medicaid enrollment will balloon, but unless the patient tells you they're eligible, you may not know. Retroactive Medicaid will also surge, but it's hard to identify what encounters are eligible for retroactive reimbursement.
Finally, as people lose jobs, change health plans, then get back to work and change plans again, it will be nearly impossible for HCOs to keep up with the changes - leaving them at risk for missed billing opportunities.
Pause Collection Efforts
Many HCOs have drastically changed their position on collections due to the current economic climate. While some have stopped collections altogether, most have at least paused or taken a gentler approach. Although it's the right thing to do, it cuts off another vital stream of revenue.
5 Steps for Preserving Your Revenue Cycle
Fortunately, there are solutions for health organizations to overcome these COVID-related challenges. Here are the 5 steps we've identified for helping you ensure financial stability during these uncertain times.
Step 1: Leverage AR
There is money sitting in your AR. As less aggressive approaches for collections are being taken, there are still other things you can do to mine the value laying stagnate in AR:
Work claims aggressively. You can redeploy staff to assist AR in working claims.
Automate claims follow up. If you can react to claim status as soon as possible and filter claims from workflows that don't require action, you can reduce AR days and accelerate cash-flow.
Consider selling portions of AR to an outside firm for a quick injection of cash.
Step 2: Modify the Patient Experience
Super charge financial clearance by using systems that automate eligibility verification and confirms you have all the correct information.
Extend the length of payment plans to receive some payment instead of none at all.
Offer mobile payments and plans to make it easier for patients to pay.
Step 3: Have a COVID-19 Strategy
Flag all COVID-19 related claims to review billing and out-of-pocket obligations.
Hold COVID-19 claims until you're clear on how to process them correctly with state and federal governments.
Place guarantor holds to prevent claims from being routed incorrectly.
Automate as much flagging and collections hold as possible to keep staff available for higher-impact work.
Step 4: Eliminate Payment Barriers
Update chargemaster with COVID-19 codes.
Train coders on new codes.
Step 5: Identify and Leverage 3rd-Party Billing Opportunities
Run eligibility checks for self-pay patients against commercial payers and Medicaid to identify any missed coverage.
Run eligibility checks for insured patients against payers other than their plan to identify any missed additional coverage.
- Monitor Medicaid to identify retro-billing opportunities for past encounters.
It's a very uncertain time for healthcare providers. By following these steps, you can accelerate cash-flow and mitigate revenue losses. The added revenue and loss-prevention will provide critical resources to rely on as you enter the post-COVID-19 realm.
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