As hospital systems and provider practices have pivoted resources to focus on COVID-19, they have experienced severe declines in patient volume and the bottom-line revenue that follows. While cash flow suffers and future outlooks dim, the healthcare industry is heading into an unsure recovery period with burned-out providers and fatigued staff.
What’s needed is rapid recovery, and that will depend on recapturing patient volume quickly. Extended periods of cancellations for elective surgeries, non-emergent procedures, and testing, and preventive care have severely impacted ambulatory and outpatient facilities, hospitals, imaging, and lab centers, and primary and specialty practices.
Fine Tune a Strategy for Rapid Recovery
Moving forward without a plan and hoping that patients will call to reschedule will not serve well. Developing a refined strategy to include telehealth services, proactive scheduling, and revenue capture through advanced automation and support where needed is the best way to ensure a strong recovery and financial future. Consider these five points:
Develop a System to Recapture and Reschedule Patients
As social distancing requirements begin to ease, swift action to proactively contact patients and reschedule them is the first step. Still, you also need to ensure that nothing has changed in their circumstances, i.e., loss of a job or health benefits, etc. Be sure to have a team available to schedule patients actively and reconfirm all information quickly, including:
- Insurance verification including demographic information, group and plan number, and in-network vs out-of-network status
- Benefits eligibility including out-of-pocket maximums, co-pays and co-insurances, lifetime maximums, and deductibles met
- Consider maximizing schedules through expanded hours and more convenient times, i.e., evening or weekend appointments
- Utilize the new opportunities afforded through telehealth for consultations, triage, visits, and follow-up
- Develop a plan to address patient concerns and apprehensions, including deep cleaning and PPE specifics, arriving and leaving the facility, and bringing guests
Be Proactive in Preparing for Visits
In addition to preparing the physical environment and the staff members who will be working, it’s important to facilitate the insurance business aspects, including:
- Financial clearance to treat the patient through an automated prior authorization process that would cut down on the burdens of the administrative time required by manual preauthorizations – if one had been obtained before the COVID-19 Public Health Emergency, it will need to be reauthorized
- Reevaluate patient education materials and update to reflect patient responsibility for immediate payment
- Prepare the patient portion due amount and notify/collect from the patient prior to the encounter
- Be sure that the facility offers the latest and most comprehensive payment options for large balances, including third-party financing
Institute a Targeted Revenue Capture Process
With the intention of seeing record numbers of patients as the recovery picks up steam, your organization may want to consider a third-party partner to facilitate coding and billing thereby lessening missing charges and charge errors. With an affiliated partner, the job of scaling up or down is removed, and smooth claims processing is ensured.
Accelerate Cash Collections with an Optimized AR Strategy
Once the service is performed, and the claim is submitted, the job is only partially complete. By automating denials management, reimbursement that might have been left on the table is captured and stale claims, are processed in a timely manner.
In addition, having a system to entice quick self-pay once insurance has paid helps to collect quickly. Consider using prompt pay discounts, payment plans, and third-party financial arrangements. Most importantly, follow up often and on time to ensure payment without involving a collections agency.
Enlist a Process to Uncover Previously Undisclosed Insurance Coverage
Insurance discovery is available through AI-driven software to locate and resubmit claims to insurance payers that were previously undisclosed and many times even unknown to the patient. This type of system is especially useful with Medicaid and commercial insurance payers.
As the post-COVID-19 recovery gets underway, patients may need a supportive hand in reengaging with the healthcare system. Being proactive in scheduling, making sure that all boxes are checked, and ultimately refining and refocusing the AR process are all ways to help bolster your financial future.
Contact us to learn more about potential recovery opportunities from COVID-19 revenue loss.