The healthcare system has been impacted by COVID-19 in so many different ways. The world of Revenue Cycle Management (RCM) has seen the brunt of it as well. Many facilities and practices are looking at their current processes for changes and improvements.
Given the development of the pandemic, there was an urgent need to capture the reporting of the conditions of the disease. The Centers for Medicare and Medicaid Services (CMS) quickly developed new codes for healthcare professionals (HCPs), primarily for labs and new procedure codes (CPT-Code) to address the pandemic. In addition, the American Health Insurance Plan (AHIP) will be implementing solutions to lower out-of-pocket costs and waive deductibles and co-pays for people seeking testing for and treatment of COVID-19.
The American Institute of Healthcare Compliance (AIHC) is working on ways to ease network referral and prior-authorization requirements. Many health plan companies have also streamlined the provider credentialing process. The hope is to quickly secure more healthcare professionals to care for the patients. They are also developing different payment methodology for reimbursement for the providers. For example, payers are reimbursing telehealth at the same rate as an in-person visit. The goal is to alleviate some of the cost to the providers as well as the patients. These efforts are intended to make the revenue cycle process seamless and cost effective. Nevertheless, RCM can never be a seamless effort unless the right solutions are put into place.
As patient volume continues to decline due to the postponement of elective surgeries, social distancing and fear of the unknown, this is a crucial time for the healthcare systems. The reduction in the number of surgeries affects all aspects of the revenue cycle, including loss of revenue. However, this may be a good time to re-evaluate current processes and come up with new and better solutions. The reality is that is many health care systems have been and will continue to sustain some financial loses and need to come up with ways to increase revenue.
As we continue to read and hear countless stories about revenue reductions of 40% or more, we should also be focusing on what can or need to be done. Organizations need to assure that all aspects of their revenue cycle are benefiting their needs. Do we have an efficient process for credentialing and contracting our providers? Do all providers have all their privileging done? Are all services being captured and coded correctly? Are the AR days being monitored closely and working timely? What is the current status of automation? Are we in a good place as far as technology? Are we capturing all data in the front-end and assuring the back-end is clean and has a profitable return? These are just a few questions that can help our providers know if they are all on the right track of recovery.
Considering the fact that healthcare providers are facing so many different issues surrounding the pandemic, it is important that we know there is always room for improvement. Some may view their current processes as cumbersome, but they should also see it as a red flag and a time to make changes. This is also a chance to pinpoint the risks and opportunities for improvements. This may entail some step-by-step changes that can offer the organizations better solutions. It may require some deconstructing of what’s working and what’s not working, and making sure the right people and solutions are implemented. There may be a need for RCM services that can focus on patient access automation, quick turnaround, provider credentialing and contracting, automated billing solutions and efficient cash management. Services that can increase profitability, increase patient experience and minimize overhead cost. It is important that providers keep in mind that the road to recovery may seem long, but as we continue to weather the storm, we know there are solutions that can improve the front and back-end RCM processes and increase revenue during the pandemic and in the future.
All Covered’s Healthcare Practice can provide technology and services to enable healthcare organizations to operate efficiently and effectively, with solutions tailored to your organization. Visit us online today.