In answer to the American Medical Association’s letter requesting financial support through accelerated reimbursement, UnitedHealthcare (UHC) announced that they would expedite $2 billion in payments over the next week to help ease the cash flow crunch experienced by many hospitals and providers.  UHC, the largest US insurer covering $150 billion in healthcare costs per year, has committed to fast-tracking payment for claims filed by hospitals, providers, and ancillary services, such as laboratory and radiology centers.

Throughout healthcare, hospitals and providers are experiencing sharp declines in routine visits, emergency and urgent care visits, and elective surgeries, significantly straining immediate operational funding needs.  John Rex, CFO for UnitedHealth Group, parent of UHC, stated that healthcare providers “are under a lot of financial stress,” and UHC wants them to be viable into the future.

Additionally, the Centers for Medicare & Medicaid Services (CMS) authorized its Accelerated and Advanced Payment Program through the end of the Public Health Emergency (PHE) for those submitting requests.  Similarly, Blue Cross/Blue Shield of California is positioning to offer financing guarantees, expedited payments, and restructuring of some reimbursement contracts. At the same time, Humana, Inc. is said to be quickly dispatching claims, among other steps.

Explaining the Decline in Cash Flow

By quickly canceling many financially lucrative procedures to create capacity for an expected surge of COVID-19 patients, healthcare facilities and providers created a lull in reimbursement flow and are finding that timing is everything.  While many have adopted telemedicine, which is helpful, it doesn’t begin to replace the lost revenue from empty surgery suites and doctors’ offices.  Many are experiencing serious financial strain with vacant facilities and idle staff waiting for a surge that, in many areas, hasn’t yet happened.

By speeding up claims processing and shaving weeks off the usual reimbursement cycle, insurers are helping ease the pressure at least until the end of the PHE.  Additionally, UHC, for example, is offering $125 million in loans to providers/facilities where they are stakeholders, and healthcare participants should see significant help from the recent federal stimulus package that includes a $100 billion fund for hospitals and other healthcare providers.

Other Areas Where Revenue May be Found 

Coding and Billing

Whether experiencing a surge in coronavirus patients requiring testing and care or sifting through a backlog of care to be billed, engaging a third-party partner to facilitate the COVID-19 coding and billing process may be needed.  It’s important to work with an experienced team that is current on all relevant coding changes that are COVID-19 and coronavirus specific, including the new telehealth guidelines issued by CMS and the AMA.

AR Optimization

A/R days outstanding continue to age, and claim denials don’t get resolved when staff is either furloughed or swamped.  Expert help, whether short-term and temporary or long-term, can facilitate A/R reduction and revenue capture with no start-up or risk and bring maximum benefit to the bottom line.

Insurance Discovery

When looking for revenue that has fallen through the cracks, insurance discovery offers the opportunity to bring leveraged artificial intelligence (AI) supporting machine learning, deep data libraries, and probabilistic analytics to uncover undisclosed insurance benefits that are available and can be billed.  Before sending what is considered “unrecoverable” to a collection agency, enlist the support of an insurance discovery team to scour their A/R.

Insurance Payers Step Up

Without a doubt, these are uncertain times for everyone, including insurance payers who have already committed to covering copays on COVID-19 related testing and care, as well as the care itself in many cases.  Additionally, they will be potentially faced with massive reductions in covered lives, even temporarily, as people lose their jobs and their employer-sponsored insurance coverage.  But to their credit, throughout this crisis, insurers have rallied to support healthcare providers. and patients and we owe them a collective debt of gratitude.

Learn more about how Infinx can support you and your organization during the COVID-19 health emergency.