How has COVID affected revenue cycle management?

How has COVID affected revenue cycle management?

The Covid– 19 Pandemic has impacted all sectors and not just the medical field. Apart from deaths from coronavirus due to infections, there is financial and medical distress. For Healthcare organizations another cause of worry is the effect coronavirus pandemic can have a negative impact on their revenue cycle. For smaller organizations with limited cash and manpower on hand can be a challenge to keep the billing office running which is the key to keeping hospitals and practices open while operating during these pandemic times.

Organizations that have robust contingency plans and implement best practices in their workplace help in the success of Revenue Cycle Management even during critical times.

The financial instability and challenges faced by organizations working in the medical sector, hospitals, and medical practices during these pandemic times are due to:

  • Canceled appointments and surgeries.
  • Costs incurred for maintaining critical equipment and also maintenance of systems given to staff and adopting WFH procedures.
  • Increased workloads and falling staff productivity due to shifts in work.
  • Adopting cost-cutting measures that may result in layoffs.
  • Denied medical claims.

In a way, the revenue cycle is an essential and very important component when it comes to managing the finances of medical service providers. The impact of the COVID-19 pandemic on the revenue cycle can be severe, but providers must manage it to meet their obligations.

Below are key considerations with financial sustainability hanging in the balance.

1. Billing and Coding: Due to changes to Medicare regulations, and from additional use of telehealth services notable billing and coding issues may arise. We have to ensure and know what is covered by health plans for both inpatient and outpatient services. With the rules rapidly changing, providers and support staff need to be properly appraised and trained.

2. Telehealth: Most outpatient visits have shifted to telehealth visits and services. In this sector we have to have answers to questions like insurance company pay rate, additional documentation requirement, and if any additional approvals requirement.

3. Changes to patient financial responsibility severely affect copayments and deductibles, along with referrals.

4. Remote Billing Work: Determining if employees can manage billing-and-collection responsibility from home. This assessment is crucial and critical to ensure cash flow issue disruptions are minimized.

5. Identification by organizations of employees to work remotely and yet be productive. Plan to be implemented regarding systems and equipment usage.

6. Ensuring adherence to regulations concerning privacy and security of personally identifiable information and other HIPAA provisions.

7. Contingency planning: Having a robust emergency preparedness planning to ensure minimum disruptions to business or updating a revised plan and implementing it.

8. Changes to Medicare regulations: With several changes implemented recently, provider organizations should review these changes and identify any additional services that may be billable. There is also the possibility of receiving accelerated or advance payments from Medicare to increase cash flow amid COVID- 19 disruptions in claims submission or claims processing.

9. Patient Financial responsibility: The pandemic has led patients to incur significant medical bills that are not covered by their health plan. Each organization should evaluate its credit and collection policies to prevent financial strain on hospitals and providers.

10. Changes to Copays and deductibles: Several large health plans have made changes to policies on patient out-of-pocket responsibility. Billing and registration staff should be aware of these changes so that invoicing and collections can continue apace.

11. Standard referral requirements: Due to changes to policies on patient out-of-pocket responsibility, ensure these changes are considered, as they could shift payment obligations from patients to health plans.

12. Resource optimization: Provider organizations should make sure the resources are appropriately allocated to meet patient needs and should include specific areas like capacity planning and have proactive revenue cycle strategies to meet patient needs in the event there is a sudden surge on existing capacity limits. The other specific area would be operational accommodations which take care of adjusting hours of operations, staffing, and documentation requirements for telehealth visits.

Staying apprised of changes across the revenue spectrum, adapting will help healthcare providers to maintain transparency and understand cash flow throughout the crises.