Five tips for improving RCM in a post-pandemic world
As a result of the COVID-19 pandemic, the American Hospital Association (AHA) estimates that hospitals and health systems have lost more than $202 billion from a drop in revenue, combined with COVID-19 expenses, during the four-month period from March to June 2020. Healthcare services expenditures also dropped 38% in April 2020, as compared to the previous year, and many practices are now contending more with patients who are unemployed or uninsured and unable to pay for doctor visits, specialty care and routine procedures. These numbers will undoubtedly rise, as nearly 27 million Americans could potentially become uninsured due to the pandemic.
Adjusting to new ways of operating during COVID-19 -- and maintaining the revenue cycle all the while – is critical as the industry continues to navigate uncertainties about reimbursement for virtual care and increasing numbers of patients losing their jobs.
Practices need to stay abreast of all of the regulatory updates and changes, including adjustments to the services covered, technology required, codes to use, data used on claim forms, and patient responsibilities. Even though many of these changes will not result in an alert from a denial, they can impact the revenue cycle.
Providers must also seek to understand the different types of services, including telehealth visits, virtual check-ins and e-visits, since the rules and coding for each are different. Identifying the right code in the right setting is extremely important too. Check with payers about their telehealth requirements for billing, including codes and modifiers, since these can vary and may continue to change. And finally, research all payers, since each has its own standards and terminology, which will need to be applied across the practice.
Navigating telehealth billing guidelines and the ever-changing requirements of CMS can be a challenge for practices, so reporting and billing processes must be flexible and easily adaptable to ensure proper reimbursements and payments.
With more patients feeling financial uncertainty or the strain of unemployment, practices should offer deferred or discounted payment plans. This can be an effective way to ensure individuals receive the care they need without negatively impacting the practice. Clear, consistent communication is also critical, so practices should be upfront about their policies so that patients understand their estimated responsibility for each visit.
Consumers adopted telehealth services in dramatic fashion during COVID-19, with usage growing from 11% of U.S. consumers in 2019 to 46% in April 2020. And patients liked the experience, with 74% reporting high satisfaction and 76% saying that they are likely to use telehealth in the future.
Telehealth is poised to be a ripe opportunity in the future, given the recent success of these offerings, combined with revised rules that improve the reimbursement for these services and technology that makes it easier for both patients and providers. Telehealth can be an additional revenue stream to help bolster a practice’s bottom line, also helping practices reach underserved populations, reduce transportation-related no-shows, and increase schedule flexibility by offering remote quality care to further maintain financial health.
Knowing how to get paid for your services—from handling claim denials and improving denial management and underpayments to following up on outstanding payments—is the key to a healthy revenue cycle. But these processes can sometimes be too much for a busy practice to handle.
Rather than overwhelming staff and having accounts exceed desired days in accounts receivable (A/R), practices should partner with third-party RCM experts who provide the consultation, expertise and resources needed to achieve their financial goals. With a third-party billing partnership, practices can reduce the burden of time-consuming tasks, such as denial management, on their billing staff and repurpose their time to focus on other critical areas of RCM, such as credentialing, to increase efficiency and improve overall financial health.
The start of a new year is a good time to review current RCM strategies, paying particular attention to key performance indicators (KPIs), such as days in A/R, net collections, average collections per visit and write-offs. Once complete, practices can identify ways to improve or adjust billing processes to optimize KPIs. One way may be to implement innovative RCM technology that simplifies reporting and meets or exceeds value-based program requirements and quality measures. Upgrades to comply with the 21st Century Cures Act will also allow for greater workflow efficiency, including billing.
Given the constant changes, it’s also critical for practices to educate employees on billing and coding best practices, as healthcare organizations forfeit millions of dollars annually by down-coding established office visits.
While healthcare providers and practices will continue to feel pressure stemming from COVID-19 into the new year, there are ways to enhance the revenue cycle in order to maintain success. By putting a renewed focus on RCM, and adopting new strategies and best practices, healthcare organizations can help their business grow healthier for the long-term.
With growing expenses and lower revenue, healthcare providers can no longer afford to wait weeks for payments to be processed or face extended reimbursement times because of denials and incorrect coding. Practices must put a stronger focus on revenue cycle management (RCM) in order to remain a viable business, reduce the risk of having to cut back on staff or practice hours, and continue delivering the services their patients expect.
About the Author
At Greenway Health, a leading health information technology and services provider, Marvin Luz serves as senior director, Greenway Revenue Services. With more than 13 years of experience in the ambulatory EHR and practice management market, he oversees the daily billing operations of revenue services for customers, ensuring compliance with divisional established policies and protocols, adherence to government and insurance payer policies and assurance of customer conflict resolution. In addition to his daily responsibilities, he also leads the Patient Call Center and Patient Accounts Receivable teams at Greenway.