There are few—if any—sectors left untouched by the COVID-19 pandemic. Of all, healthcare has been among the most severely impacted. So many health systems and provider organizations were struggling before the pandemic. Now they face the fallout of a more complex reimbursement process for COVID-19 claims.
It is estimated that the American healthcare system will have lost on average $50.7 billion per month between March 1, 2020 and June 30, 2020.[1]
One of the best ways to prevent further damage to the bottom line is to take a hard look at the existing revenue cycle processes. Sometimes even small adjustments can create big returns both in the short-term and the long-term. The following are five opportunities to do just that:
- Clean up the patient registration process. Denied claims means denied revenue, and denials are one of the leading factors for delayed reimbursement. Since most denials stem from issues in the earliest stages of patient engagement, this is where providers should focus first. Fortunately, patient registration technology and intelligent workflow processes can eliminate many issues that lead to denials. As a result, providers receive more accurate patient demographic information, as well as more up-to-date insurance coverage and eligibility data. Billing staff will have greater insight into prior authorization requirements and documentation needs, which leads to meeting filing deadlines. Denials from missed filing deadlines are some of the most difficult to overturn.
- Button up the claims submission process. Nearly 15% of all denials are due to missing or inaccurate claim data. Using a front-end claim scrubbing tool can eliminate these types of errors before claims have a chance to be rejected; imagine what eliminating 15% of denials could do to improve resource utilization and cashflow. Providers should also make sure billers are certified and that they stay on top of changes in coding and industry regulations.
- Rethink how to manage denials. While it’s unlikely providers can eliminate all denied claims, they can make significant improvements to their bottom line by automating as many denial management workflows and leveraging insight from analytics, making it possible to capture more revenue with less effort. Denial management software combines data with analytics to give staff greater insight without having to spend time manually researching each claim. This also helps by providing workflow tools that categorize denials for easier rework and that allows staff to work by exception. The result is more effective use of resources and fewer write-offs.
- Evaluate patient accounts. Patients are facing intense financial hardships due to COVID-19. Long bouts of unemployment have left many to make difficult decisions such as whether to pay rent or buy food. The last thing health systems and provider organizations want is for patients to put off needed care because they’re not sure they can pay. The best thing providers can do is to make it easier for patients to pay. Flexible payment plans are especially helpful at this time, customized to each patient’s unique financial situation. These should include the ability to roll up future charges and those of family members into the plan. When the patient’s financial situation changes, plans can be updated. Another way to make it easier to pay is to offer a variety of ways to do so, such as a patient portal, digital payments, automated phone payments, or through customer service.
- Be prepared for COVID-19 claims. While many insurance companies have agreed to pay for most testing and treatment for the virus, there will still be situations where patients will have to pay for all or part of their treatment. How do you know when to bill the insurance company, when to push the claim through the CARES Act process, or when to bill the patient? If staff members are not up to date on governmental and policy changes regarding the COVID-19 reimbursement processes, it can be helpful to partner with industry experts who are. Choose a vendor that:
- Focuses solely on the healthcare industry
- Ensures all billers and collection experts are fully certified
- Uses the most advanced revenue cycle technology and analytics
- Manages the entire follow-through process
- Offers an extended business office option to work as an extension of your existing billing staff
The best vendors will take a holistic approach to the revenue cycle by managing every aspect: denial management, low-balance and aged accounts receivable management, third-party liability management, and health information system conversion support.
The time to act is now
These are challenging times, and with COVID-19 not showing signs of ending, they could stay challenging. Health systems and provider organizations can reduce the impact by taking proactive steps now to improve existing revenue cycle processes. And for those processes that require expertise from working with a wide range of providers, working with industry experts can alleviate the burden and ensure every dollar is captured.
[1] https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due