Many healthcare systems are seeing another rise in COVID cases. Further fine-tuning of your claims cycle can mitigate the effects of erratic claims volumes on revenue during the pandemic.
After an initial drop in COVID cases after the vaccine became available to those 12 and older, recent statistics say it is again on the rise. USA Today reports, "Daily coronavirus infections (in 2021) are more than four times what the US was seeing on Labor Day last year," an increase of 316%. US Health and Human Services are reporting hospitalizations are up 158% from last year.
Over 50% of organizations responding to a Healthcare Financial Management Association survey in April 2021 said that claims volume was "erratic and unpredictable" during COVID. Although many organizations made operational adjustments to claims workflows during the pandemic, there are still lessons to be learned to protect your organization from erratic revenue due to claim volume variations.
“Many organizations know what adjustments need to be made to their revenue cycle management,” said Vipul Bansal, CEO and Group President of Medusind. “The challenge is putting that knowledge into action. Now is the time to fine-tune your claims cycle to ensure revenue keeps flowing if or when COVID causes volumes to fluctuate again.”
Since controlling front-end activities is the most straightforward, Bansal recommends revenue cycle operations fine-tune three pre-submission activities to keep payments on track during the pandemic.
Avoid unnecessary claims submission delays
If your organization holds claims several days or even weeks to work around deductibles, evaluate if that strategy works for or against you. Many large payers reimburse electronic claims in two weeks or less, so holding claims too long may be doing nothing besides delaying payment. Additionally, high deductible plans mean that some patients will never meet their deductible in the calendar year. You want your organization to be one of the first bills paid, not one of the last.
Focus on patient information accuracy
Working through denials is time-consuming, expensive, and frustrating for both providers and patients. Staffing changes, like those due to COVID, can be a leading cause of demographic and verification denials – some of the easiest to avoid. Many healthcare team members aren’t aware that incomplete or incorrect information can have dire revenue implications. Confirm every team member (especially temporary personnel) who works with patient data, both administratively and clinically, is aware of the critical nature of correct information. Don’t underestimate the power of continued education to reduce demographic and verification denials.
Encourage providers to release charts promptly
Health care workers are doing the best they can under challenging circumstances, and in some cases, it may be reasonable for providers to delay signing off on charts. However, other physicians aren’t as affected by the pandemic. Consider putting a deadline on chart submission from those physicians to balance against unavoidably delayed charts. As with correct patient information, sometimes providers aren't aware of how a seemingly small action, such as releasing a chart, may have broader implications for your revenue cycle.
Strategies to fine-tune operations post-COVID
Use the right people, process, and technology
Although we may be experiencing another upsurge in COVID, some normalcy is returning. Post-COVID, continued emphasis that the revenue cycle is a team effort that depends on the right people, processes, and technology to be successful. Areas of fine-tuning after COVID may include:
- Gaining support from the executive suite. Many CFOs only have a general knowledge of how the claims cycle works. Consider inviting your management to walk through the claim journey with you, starting with the personnel that takes calls for appointments through the process to patient collections. If they understand where the roadblocks are, they are more likely to support your efforts to fix them.
- Evaluating day-to-day operations against standard operating procedures (SOPs) to pinpoint strengths and weaknesses. Chances are many processes used today deviate from your SOPs. Find out why. It may be because innovative staff figured out a more efficient way to get things done. Share new ideas and adjust procedures accordingly. In other situations, steps may be overlooked or done incorrectly. Now is the time to make corrections and reeducate where necessary.
- Assessing revenue cycle tools. Technology is forever evolving. Sometimes, it is not easy to discern if you need a new system or the system you have is not used to its full potential. Busy billing departments often skip platform update training. Even the most experienced operators cannot use software efficiency improvements, like shortcuts, if they don’t know about them. Make sure you are effectively using all the resources available before deciding on a change.
About Medusind:
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