Every practice looks to have experienced and qualified healthcare professionals to run their revenue cycle management requirements. Yet they have to settle for less because the market doesn’t have too many of them to offer. And this scarcity has further been exacerbated by the pandemic. The stress of the pandemic has either forced many professionals to leave the job abruptly or have forced them to retire because of significant fall in patient volumes, as in specialty practices. And now, while coming out of the pandemic, these practices are feeling the impact of not having qualified professionals. After all its a specialty-driven practice and running it with people not attuned to the specialty is like disaster waiting to happen.
Now before we look into how RCM has changed over the years; we must first look into how the pandemic has changed the RCM process for the worse. The magnitude and suddenness of the outbreak let loose such an unprecedented havoc that hospitals were by no means prepared to take it on. They were not able to prepare new plans to respond to the growing amount of coronavirus patients, fell short in sourcing rapid diagnostic kits to secure sufficient personal protection equipment for workers and figure out how to manage an overflow of patients. Similarly, guidelines for Corona virus billing kept changing, making it difficult for the billing team to come to terms with the changes at a short notice. Just as these issues got tougher for the administration, the revenue cycle team were all at seas.
| If COVID-19 continues to spread, it may cost the healthcare system up to $654 billion. |
Hospitals found it impossible to identify changes to payer rules around COVID-19. Consequently, the staff couldn’t be kept informed on the variances in billing rules by payer. This exposed them to possibilities of high denials, and it was this uncertainty that contributed to the slowdown. There was widespread confusion on three counts – the billing criteria for COVID-19 and telehealth claims; amount that could be anticipated as reimbursement from the payer for specific services and the actual payment received, which added to the plate of the denial management team.
| A McKinsey & Company report says 76% of Americans are highly likely to use virtual care in the coming days. Also 74% said they’re very satisfied with virtual care. |
Outsourcing RCM Helped Providers Counter the Stress of the Pandemic
Several practices could steer through the crisis triggered by the pandemic because they had partnered with outsourcing vendors before the onset of the outbreak. These partners had such robust and flexible revenue cycle management workflows that the disruptions introduced by the pandemic had little impact on their workflows. They were quick to identify the changes needed and molded their workflows accordingly to keep revenue inflow unaffected. One such step taken by mature vendors was to stay in touch with payers on a continuous basis to be clear about their expectations. When there was a variance, they followed up quickly — within a month of payment — to recover the short shrift. This helped in clearing the air on denials for cost-sharing based covid-19 testing and even denials for readmissions for non-Medicare visits
Vinoth from MedbillingExperts says “ It has been a great learning experience for our practice. For instance, the difference between hospital-based telehealth visit and a virtual counseling. Understanding the coverage limitations was such a challenge and we could overcome it just because we dialed up the payer for every little question“. Thus by delegating this critical task to third-party companies’ providers could sustain themselves at a time when resource shortage was at an all-time high.
And how did third-party adapt to the crisis triggered by the virus in their own countries?
” We were quick to realize the possible implications of the pandemic and prepared ourselves early for the change. For instance, just before the imposition of the lockdown, we readied a hybrid staffing model i.e. part staff in-office and part operating remote” added Vinoth. “This had a two-prong effect – helped us hold on to the culture when the team was not physically together and send across the message that the revenue cycle employees were supported and appreciated. Adequate training was provided to team leads and managers on how to handle remote staff so that they are always engaged, get on time support, and get the feeling that they are working together towards meeting a common goal of error free revenue management at the time of a crisis.”
Post Covid Requirements for Revenue Cycle Management
In a post Covid-19 scenario provider will have to cope with the following challenges:
High Chances of Revenue Loss
Some common scenarios in the post-Covid 19 world include a fall in outpatient and inpatient volumes for elective care; rising treatment costs for every COVID-19 patient, get paid for telehealth services at lower rates and no collections or delayed collections of co-pay and deductible.
How Outsourcing Can Helps
Ensure operations meet the required speed for proper cash inflow with on time claim submission and follow-up for delays. Third-party vendors have a flexible workflow which can be redesigned to match the demands of the changing times.
Patient Payments
Because of loss of employment, patients will not be in a position to cover their part of the costs. Also because of unemployment, patients may avail medical services for which they are no longer eligible, leading to claims rejection.
How Outsourcing Can Help
Third-party vendors automate the eligibility verification process that assists in capturing the latest eligibility data and get accurate insights into patient dues. Likewise they can assist in financial counseling and explaining other available payment plans for them.
| The Revenue Cycle Management Market Size is expected to cross US$ 135.12 Bn by 2027 |
Telehealth
In a post-Covid world, it’s not clear if there will be parity reimbursements for telehealth services. Private payers may introduce changes to virtual care coverage. A fall in rates without an equal fall in patients availing virtual care, will trigger a new and increasing gap in revenue
How Outsourcing Can Help
Ensure maximum reimbursement for providing telehealth services by being on top of payer requirements and ensuring correct clinical documentation from telehealth platforms to EMR and billing systems.
Resource Crunch
Staffing demand will continue to remain unpredictable in a post-covide age. As a result front-, middle- and back-office functions will take a hit and RCM workflows that depend on manual intervention will slow down and become prone to errors.
How Outsourcing Can Help
Third-party RCM service providers can help overcome staffing uncertainties by providing flexible staffing strategies, such as work from home options, and service delivery from global centers. Additionally they bank on sophisticated tools to streamline workflow delivery and ensure hitch free process.
Conclusion
Forward-thinking third-party RCM service providers have leveraged the crisis to hit upon new types of workflows that can seamlessly integrate front- and back-end claims processing. Again, the compulsion to stay afloat has forced them to embrace new technologies like automation for simplified workflows, a dynamic staffing model and other technologies to empower managers to coordinate seamlessly with remote workers. Therefore, third party service providers have been successful in providing end-to-end visibility across the claim lifecycle, the disruptions notwithstanding. So, by banking on outsourcing, practices can focus on operational excellence without having to bother about the financial health of their practice.
Get a Glimpse of How Our RCM Services Help You Sustain Your Revenue During the Pandemic?
We have realized that as the pandemic tightens its grip on the global economy, resource scarcity will continue to be one of the biggest challenges in executing RCM services. This is why we have cross trained our experts on functions like linking authorizations, clinical documentation, denial appeals, among others. To deal with employee attrition during the pandemic times, we maintain high-quality standard operating procedure documentation. This eases for us the onboarding and training of employees. Our revenue cycle management process is enabled with predictive modeling techniques. We utilize predictive modeling to analyze payer behavior to predict the chances of accepting or denying claims.
Who Are We and What makes us a Reliable RCM Partner?
MedbillingExperts is a healthcare back office service provider catering to hospitals based in the US. We specialize in a range of services and RCM services happens to be one of them. During the last one year we have assisted several practices stabilize their RCM process by taking several proactive steps to stay on top of changing guidelines. Some of these include designing a long-drawn RCM strategy, to tackle issues beyond COVID-19; build on the capabilities of digital technology and redraw process flows to make RCM more streamlined and effective. If your business is looking for an outcome-based model in a post-covid era get in touch with us now.
