Understanding the Healthcare Practice Revenue Cycle and how it has changed during COVID-19

The unprecedented COVID-19 pandemic has changed every sphere of life and the economic system as we know them. These changes are unanticipated, and it was never expected that such a lasting impression would be made on the global economy. The healthcare industry has also been hit hard by the virus.

While people in most professions are working from home and trying to reduce the burden on the healthcare system by staying safe, medical professionals have had to buckle up and face the onslaught head-on. The impact of the pandemic on the healthcare sector can be felt not only through the number of patients coming in, but also by the uncertainties over the coverage provided by earlier established claims practices.

The concerns of the medical professionals thus go beyond the risks that they are facing in treating patients; the focus is also on the management of the healthcare revenue cycle and how their financial operations can be kept running.

In a bid to best utilize the resources that hospitals and clinics are left with, reviewing and fine-tuning the hospital revenue cycle management is taking center space in the minds of decision-makers. From the point of view of revenue collection, both patients and providers are having to adapt to the changes. There is a struggle to understand the way insurance policies are being affected due to the pandemic.

The healthcare system depends significantly on insurance claims and their successful processing, which is why understanding the impact of COVID-19 on healthcare revenue collection has become all the more important. Government regulations surrounding the healthcare industry have also undergone necessary revisions.

The Healthcare Insurance Portability and Accountability Act (HIPAA) is also addressing the requirements for claims submission. In the middle of all this, how the revenue cycle is faring needs to be analyzed in greater detail.

Some Novel Challenges to the Healthcare Revenue Cycle

The healthcare revenue cycle comprises administrative tasks including generation of medical bills, management of patient eligibility verification, and subsequent closure of claims. In the face of the pandemic, healthcare providers are having to change the way they bill in exchange for the services provided.

Since the health of a revenue cycle depends on successful billing and collection, it must be ensured that the bills are created in compliance with the current regulatory guidelines.

Some of the major challenges in the healthcare revenue cycle during the current crisis are listed below:

• Patient account management – This roughly means registering a patient when they arrive to receive healthcare services and generating bills as per the services rendered. Ascertaining whether patients have coverage for the necessary treatment is part of the process. A critical aspect of the healthcare revenue cycle, it ensures a steady stream of income for the providers. But owing to the ongoing pandemic, most facilities are operating with reduced administrative strength and hence, patient account management is inaccurate. Maintaining a smooth workflow in this matter is of utmost priority for the continued functioning of healthcare facilities.
• Maintaining stocks of PPE for COVID-19 related treatment – Bearing in mind the contagious nature of the virus, treating patients with COVID-19 requires the staff members to don the necessary personnel protective equipment. But maintaining a sufficient stock of PPE is becoming a challenge as global stocks of PPE continue to dwindle. Crucial medical equipment such as ventilators is also in short supply. In addition to the regular stock management, the added overheads are likely to put a strain on the bottom line. This makes accurate and fast revenue collection all the more important.
• Intensive services for corona care – The services required for patients affected with COVID-19 are likely to be more cost-intensive, not to mention the strain this has put on the limited resources available. Whether or not patients are insured for these treatments needs to be ascertained beforehand to ensure that collections aren’t hampered in the end in the form or claim denials or rejections.
• Testing related reimbursement – With the vast number of tests being performed to screen the population, the collection of reimbursement for the tests is being given much thought by regulatory agencies. New guidelines are being brought into place to outline the codes that laboratories have to adhere to for billing these new diagnostic tests.
• Telehealth and virtual care– Patients seeking treatment unrelated to COVID-19 are now being provided with healthcare services in virtual platforms. This form of patient care is now acknowledged by the regulatory bodies, making such platforms a healthy source of revenue for physicians and facilities, but an additional responsibility for the finance department.

How has the Existing Parts of the Revenue Cycle been Affected by the COVID-19 Crisis?

• Billing and Coding-related Changes

In times of a disease outbreak, providing care to those who require is crucially dependent on the successful billing of the services. This can be a challenging task for small to medium practices that typically have inadequate resources. But to their relief, RCM services are helping pan out the way billing and coding practices must be adjusted to handle treatments relating to COVID-19. Minimizing coding and billing-related errors is the need of the hour, as these would hamper the flow of the healthcare revenue cycle and create a burden for the skeleton staff that is struggling to keep practices open.

New codes are being assigned by the regulatory bodies to the bills which will be generated during this period. Billing guidelines for non-face-to-face services are also being outlined so that patient care can also be provided virtually. These unconventional care practices need specific guidelines that can make it easier for healthcare services to establish the revenue that can be collected.

• Accounts Receivable Management

At this time, it is all the more important for A/R management to function like a well-oiled machine that reduces errors and delivers better outcomes. Patient eligibility verification will need to be carried out with a renewed eye for detail. Denials and rejections must be swiftly dealt with so that the healthcare revenue cycle does not get impeded needlessly. Automation can provide some degree of respite to the bulk management of data generated during this period. Automated payment options will also make revenue generation smoother; however, errors are also likely to occur if the process is not executed by specialists. In this case, enlisting the capabilities of competent revenue cycle management companies will help cut back on denials and thus expedite revenue collections.

• Resource management

The massive burden on the healthcare system might overpower the abilities of the hospitals and clinics, not to mention the smaller organizations. Managing resources at this time is the determining factor between keeping practices running smoothly and shutting them down. In this matter, the resources that are critical for operations to be running smoothly must be given the highest importance. And procedures or services that are a drain on the healthcare revenue system must be identified and addressed aptly. If certain services can be deferred, then they ought to be done to direct the focus on the more critical areas.

• Patient flow and financial clearance

Patient information gathering that had hitherto been done upon the arrival of the patient, can now be executed remotely to determine their eligibility for the service they seek. To this end, RCM services can also be employed to check for the patient’s insurance eligibility ahead of appointments, thereby saving time and resources. Outstanding balances can likewise be traced and payments can be processed smoothly.  This can help to avoid unnecessary hassles (particularly during the pandemic) at the hospital premises and in turn, streamline the check-in process. Scheduling appointments for patients who have been postponing care due to the fear of infection by nosocomial means can also help to prioritize urgent services. Reduction in cancellations can be achieved by managing patient flow in this manner.

• Claims Management

If errors in patient eligibility verification go undetected, claims are likely to be denied by insurance companies, implying serious consequences for small practices during the current virus crisis. This generates additional paperwork for the already understaffed practices. In this situation, revenue cycle management companies can provide their expertise to deal with the handling of denied or rejected claims. Frequent follow-ups are desirable when denial management is underway. Relying on RCM service providers can reduce the turnaround time for claims management as they are well-equipped to carry out compliance checks as well. The overall benefit to the revenue cycle can be easily assessed by the growth in revenue collection once the pandemic gets over.

• RCM Reporting

Having the revenue cycle analyzed by an external agent provides valuable insights into the possible leakages in the system. Services of revenue cycle management companies aid healthcare practices to identify hidden problems which had so far gone undetected. They help clients address the revenue process bottlenecks adequately, thus enabling them to be better prepared for times like these. Commonly made errors can thus be identified and subsequently rectified.

Preparing for the Future

Certainly, the end of the COVID-19 pandemic would not be the end of the other serious threats to the healthcare ecosystem. It wouldn’t be amiss to say that preparing for emergencies is part of the process of being successful in the healthcare sector. Future-proofing the hospital revenue cycle management can be thought of as a foresight rather than regretting indecisive actions in hindsight. Emergency plans must be taken into consideration to brace for any similar events which might affect the revenue cycle in the long run. The following are some of the services that revenue cycle management companies can bring to the table not just for dealing with the current scenario but also as possible solutions to future unforeseen encounters:

• Remote management of revenue cycle – To keep all essential staff engaged in core business activities, revenue cycle maagement can be outsourced to RCM service besides supporting clients for billing and coding tasks, the service providers also help the client analyze where and how the revenue can be increased. As outsourcing agents usually earn by commissions, they are more likely to be incentivized to increase the revenue collection for clients, and by extension, for themselves.
• Assign work remotely, invest in communication – Expenses in the maintenance of office space and logistics can be decreased considerably by investing in secure communication platforms for the hospital staff. This can make the planning of day-to-day activities smoother while, at the same time, make staff performance management easier. These are certainly some of the services that can be availed of well after the immediate threats to revenue collections cease.
• Paperless activity recording – The larger the organization, the more data they have to deal with. The contemporaneous recording of activities is a highly advisable practice in the healthcare system, as traceability is enhanced with electronic data signatures. Moreover, cloud storage of electronically generated data guarantees information safety and easier retrieval without having to rely on on-premises infrastructure.
• Revision of policies and SOPs for the revenue cycle– Clear and comprehensive documents must be in place to outline the steps to be followed when unprecedented events disrupt the workflow. Planning for the future helps mitigate business loss and bounce back on the revenue track. Outlining the steps to be taken in case of a disaster keeps operations running without having to pause for new guidelines to be hashed out on the spur of the moment. Policies must also be revised to include special clauses for contingency plans in case unforeseen pandemics were to break out again.

Restoring the ecosystem of the healthcare revenue cycle is the chief priority of the industry at this point. Although the pandemic has made us aware of the frailties of the global healthcare system, it has also given us the opportunity to work on improving the existing systems. It would be foolhardy not to learn from this unique unfolding of events in human history.

Adapting to the changing times is the only way forward if healthcare practices wish to remain functional well into the future. Survival of the fittest has always meant the ability to adapt to changing environments. At the end of the day, one of the primary goals of healthcare practitioners should be the appropriate implementation of revenue cycle management strategies, so that patient care does not suffer.

Who We Are and Why We Are an Industry Authority?

This article is brought to you by MedBillingExperts, a well-known revenue cycle management service provider for US-based healthcare companies. With over a decade of experience in managing comprehensive revenue cycle management requirements of our clients, we have the resource and knowledge to assist you handle this critical process in more efficient ways. Our clients have leveraged our expertise to earn greater revenue without having to shift their focus from core business activities.