Healthcare Revenue Cycle Management and COVID-19: Coronavirus Impact & Management Strategies

Medical Coding Challenges

97% of America’s healthcare organizations have experienced some disruption due to COVID-19.

As states re-open, healthcare organizations continue to navigate healthcare revenue cycle management. Some organizations are managing more effectively than others.

Many organizations have faced billing and coding challenges during the COVID-19 pandemic.

To navigate the pandemic, your organization needs to know what is covered by health plans for both inpatient and outpatient care.

Rules are changing constantly. That means staff require frequent training and regular updates to avoid billing and coding problems.

Many outpatient facilities are scheduling telehealth appointments, for example. Some insurance companies treat telehealth appointments the same way as in-person appointments. Others treat them differently. Check if the insurance company pays the same full rate for telehealth appointments. Check if the insurer needs further documentation or approvals.

Billing Challenges

Many healthcare organizations have shifted their billing office to work remotely. With some preparation, organizations can handle billing responsibilities from home.

To setup remote billing, an organization may need to give employees remote access. Employees may need to access certain systems and equipment to remain productive.

Employees also need to adhere to regulations – including privacy and data security. Working from home introduces new challenges with HIPAA, and your organization needs to address these challenges before compliance issues occur.

Business Continuity Issues

COVID-19 has made some healthcare organizations starkly aware of business continuity issues. Some organizations have strong emergency preparedness plans. Others do not.

Every healthcare organization has some type of emergency plan – but few healthcare organizations were prepared for a multi-month pandemic-related shutdown.

You may think it’s too late to address emergency preparedness for the coronavirus pandemic. However, nobody knows what happens next: a second wave later this year could be worse than the first wave. There’s no such thing as too much preparation.

Changes to Medicare

Several Medicare changes were introduced in recent weeks. Healthcare organizations need to review these changes and stay up-to-date on other upcoming changes.

Some of the biggest changes involve billable services, including services that can and cannot be billed under Medicare. Medicare allows billing for the treatment of uninsured patients with COVID-19, for example, or providing telehealth care.

Another big change is with Medicare cash flow: organizations can receive accelerated or advance payments from Medicare in certain situations, increasing cash flow at a time when needed most. By taking advantage of these cash flow changes, organizations can minimize COVID-19 disruptions.

Collecting from Patients

Patients are facing higher financial responsibilities during the coronavirus pandemic. Some patients are facing financial difficulties because their health plan lacks coverage for coronavirus-related bills.

Today is a great time to evaluate your organization’s collection and credit system. Each organization should evaluate its credit and collection policies. Pay close attention to changes in:

Copays and Deductibles: Some of America’s largest insurers have changed copay and deductible policies, including out-of-pocket responsibilities for patients.

Standard Referral Requirements: Consider standard referral requirements, as this can move payment obligations from the patient to the insurer.

By keeping staff trained and up-to-date on patient financial responsibility changes, healthcare organizations can optimize revenue cycles during the pandemic.

Other Things to Consider

Healthcare organizations are dealing with countless challenges during the coronavirus pandemic. Other things to consider with revenue cycle management include:

Capacity Assessment: Hospitals in many states are facing a surge in patients, including surges that overwhelm capacity. Your healthcare organization needs to develop proactive revenue cycle strategies to ensure you continue to meet patient needs when nearing capacity.

Staff Management: Your staff are on the front line of patient care. Has your organization created proactive plans for hours of operation, staffing and documentation requirements, telehealth accommodations, and other unique situations created by the coronavirus?

Hire a Consultant

There’s never been a better time to hire a revenue cycle management consultant. A good revenue cycle management consultant spots inefficiencies that impact revenue.

By implementing a consultant’s recommendations, your organization can thrive during the pandemic, surpassing revenue management cycle obligations and goals.

Revenue cycle management consulting is an investment. A good consultant firm provides a return on that investment, providing actionable recommendations that impact your firm’s revenue immediately.

At HMI Corp, we have offered revenue cycle management services since 1989. As a diversified healthcare company, we provide a spectrum of revenue cycle management services, including charge capture, chargemaster reviews, medical bill audits, and claims reviews.

Our clients include physician groups, large teaching hospitals, and organizations of all sizes in between. Contact us today to discover how we can help optimize revenue cycles for your organization. Our goal is to help you meet revenue goals while maintaining quality and compliance standards.

Final Word

The COVID-19 pandemic has introduced many challenges for healthcare organizations.

The situation is fluid, and it’s uncertain what happens next. However, organizations must continue to meet obligations and missions throughout the pandemic.

Using the strategies above, healthcare organizations can manage and thrive during the coronavirus pandemic, ensuring they meet revenue cycle goals.