As the vaccines are rolled out and we embark on what we hope to be a better 2021, it’s essential to take stock of the high-impact trends that resulted from the coronavirus and its impact on the healthcare system. Disruptions occurred in all aspects of healthcare delivery, including these four far-reaching areas:
Operational Restructuring – During the past year, hospitals and practices have had to deal with staff furloughs and work-at-home changes, and conversely, overworked staff and burnout in ICUs and emergency departments. Beyond the people issues, there were significant challenges early on in acquiring PPE and emergency equipment; problems that continue to linger.
Unprecedented Financial Challenges – From the cancellation of elective procedures to the postponement of testing and care, revenue for hospitals, outpatient facilities, and provider practices declined sharply leading to an estimated loss of over 323.1 billion according to the New England Journal of Medicine.
Strategic Complexities in Planning – For 2021 and beyond, COVID-19 has made planning particularly complicated to include lost revenue, the profound effects of deferred care, and the increased use of telehealth medicine.
Equity of Healthcare Delivery – An unforeseen consequence of the pandemic is the sharp relief brought to health equity and racial and economic disparities.
As healthcare leaders grapple with issues ranging from overextended facilities to severe burnout of staff and providers, they are also struggling with how to bill and collect for all these services. Many are left with questions and concerns, including:
Ongoing confusion over medical coding and claim requirements for COVID-19 testing and care
Staffing and scalability for continued erratic or unpredictable claim volumes in a social distancing environment
Decreases in productivity caused by furloughs, layoffs, and temporary hour reductions
- Reduced staff due to COVID-19 illness resurgence following the holidays
Intended Fixes Brought More Questions
While the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA), responsible for CPT coding, and the World Health Organization (WHO), responsible for ICD-10 codes, were quick to draft guidelines for the new reality, it took several months to iron out details as claims worked their way through the system.
Healthcare systems, providers, and insurance payers were impacted financially as patient care shifted to covering acute COVID-19 in-patient care, increased telehealth services, and reduced elective procedures and in-person care. At the same time, workflow changed dramatically with more people working from home or remote locations.
Scalable Answers to Meet the Challenge
With a combination of advanced technology and third-party expert support, scalable answers exist to bridge the workflow shortfalls and reduce the overall revenue gap being experienced by many in the healthcare industry.
Once a patient is seen, the first step is to determine accurate coding and level of service. However, whether it’s due to staffing issues or changes to the coding structure for COVID-19, procedures can be under coded, miscoded, documentation is missing, or level of service is misclassified. This causes severe problems that impact revenue, including denials, underpayment of services, and abandonment of claims.
Setting up provider and department coding guidelines is one way to ensure timely, accurate charting and documentation is completed and turned in for claims processing. An additional solution might be to engage a third-party partner that can provide scalable and accurate medical coding services, absorb the complex COVID-19 changes, and the coding specialists’ training and certifications required. They can also process denied claims through payment, identifying problems, and building in safeguards to prevent future occurrences.
One of the most significant pain points during the COVID-19 pandemic is the inability to quickly scale for the workload and the havoc it causes through the payment billing cycle. Everything can be either overloaded or slowed to a crawl based on staffing within the billing department. from charge entry to payment posting. Add to that the social distancing guidelines as people moved to a work-at-home model, and you have a recipe for disaster.
In addition to the general mayhem created by the COVID-19 pandemic, add the general staffing issues from unexpected changes, family leave requests, and hiring mis-queues that continue as part of doing business, and you create bottlenecks that slow down processing and impact bottom-line revenue. Engaging a resource that can absorb the scalability issues and also resolve credit balances and contract management that would allow administrative staff to respond to patients’ and providers’ needs in a more timely fashion.
Denials management is often cited as an ongoing problem in many hospitals and practices. To optimize AR post-COVID-19, state-of-the-art AI-driven automation solutions are available that can utilize proprietary recovery prediction algorithms to focus efforts on which denials are collectible so that energy is spent on the recovery of revenue and increase of early cash flow. By reducing write-offs and identifying the next best activity through automated machine learning algorithms based on payer guidelines and procedures, you can be assured the maximum revenue is collected.
With several vaccines authorized for use and states well on their way with vaccine programs, there seems to be an end in sight. However, the changes to the healthcare delivery system will be felt for years. Meet the future now by adopting systems and advanced technology that can make a major shift in your overall financial performance and safeguard against future shocks.
Contact us today to learn more about how Infinx can help you meet COVID-19 revenue challenges head-on!