According to a leading market intelligence group, the number of patients in the US accessing hospital care declined by 54.5% between March 22nd and April 4th of 2020. Hit hardest were specialties that rely on elective surgeries and non-emergent care. Orthopedics declined by 74% with knee replacement surgeries down 99% and spinal fusion down by a remarkable 81%.
The American Hospital Association (AHA) recently projected losses due to COVID-19, and the public health emergency could top $200 billion by late June. And to complicate things further, hospitals experienced a rise in supply costs as they prepared for patient surges in care and testing. Some projections estimate personal protective equipment prices have increased between five and seven times the normal contracted rate.
Have Government Support and Relief Efforts Helped?
On March 27, 2020, Congress passed a $2 trillion economic aid package (CARES Act) with $175 billion to support the healthcare industry. However, this amount hasn’t been enough to offset the lost revenue and increased expenses brought by the pandemic.
In addition to postponing valuable capital projects and requiring executives and stakeholders to take pay cuts, hospitals and provider groups are furloughing staff to cut costs hoping to reassemble their workforce when volume increases. Hospital systems large and small have laid off between five and 15% of their workforce in the last quarter with more to come as the pandemic speeds up.
Are There Solutions Available?
Anytime there are reductions to the workforce, non-essential personnel are targeted first, and that often includes administrative staff. The problem with this is that it often impacts the financial arena where the money is billed and collected, leaving the hospital without the resources to maximize the bottom-line fully.
Claims that are denied sit stagnant instead of being reworked, A/R’s are left untouched, and insurance requirements are ignored – money is literally left on the table!
But as a hospital struggles with cutting overhead costs, can improve revenue through better claims reimbursement? Yes, by utilizing tech-enabled, automation and AI-driven systems that manage the workflow in real-time with precise algorithms that ensure accurate dispensation.
Let’s look at three types of advanced AI-driven, cloud-based solutions that meet all regulatory security criteria available today:
Prior Authorization — Insurance payers control costs using prior authorizations (PAs), but the process has led to massive inefficiencies and redundancy. An AI-driven system would allow necessity to be determined through advanced automation, information to be assembled and submitted, and follow-up to be completed in real-time.
This eliminates the bulk of the tedious, manual workflow and improves the PA workflow so that claims aren’t denied.
- Denials Management — By using AI-driven technology, A/R’s can be optimized and money collected to aid in minimizing the current cash crunch. Claim denials often place last in importance because of their tedious nature, but by using advanced automation, this process becomes much more manageable with significantly improved results.
- Insurance Discovery — With coverage in place that isn’t divulged by the patient (known or unknown), money owed often ends up in collections or written off. By utilizing an AI-driven program that taps into massive clearinghouses of insurance information, unidentified insurance is discovered so that claims can be resubmitted and collected.
As we all navigate these uncharted waters, consider partnering with Infinx to address ways to improve your bottom-line using tech-enabled services. As evidenced in a recent case study, Infinx has substantiated results that include 100% compliance on all-payer guidelines and protocols on hospital PA projects with a 98+% error-free audit result on all documentation. We can help you succeed in this challenging environment.
Contact us to discuss quick deployment of AI-driven solutions to support your bottom-line efforts.