May 12, 2020

COVID-19 Considerations for Revenue Cycle Leaders

Spencer Thielmann

COVID-19 continues to disrupt every aspect of the healthcare revenue cycle landscape and, as a leader, you need to maintain awareness of countless regulatory adjustments, but also the broader impact on your employees and patients. In the billing space specifically, we are working with our clients to maintain stability around what we know and plan ahead for what we do not.

In this post we highlight keys areas in billing and collections that will significantly impact your organization and should not fly under your radar.

  • Sync your strategy– Your days over the last 6-8 weeks have no doubt been dominated by COVID-19 related meetings, impact analysis, and surge planning sessions. Take an active role in ensuring your entire department is aligned with the organizational strategy. This entails regular messaging to billing teams on expectations and making requisite policies and training materials accessible to those that may need them. Changes in billing regulations, DNFB approaches, and even HR directives need to be disseminated rapidly. You will quickly lose momentum and productivity (which translate directly into cash) if your staff and management teams are spinning their wheels instead of executing and cohesive vision.
  • Maintain claims volumes wherever possible– Volumes for elective services have cratered and this only underscores the need to maintain claims volume where you have it. We have seen clients take varied approaches when it comes to handling COVID-related and non-COVID telehealth cases from a billing standpoint. While some are being cautious and holding most claims, others are pushing claims through to minimize cash disruption. We recommend a measured approach that focuses on segmenting these services and developing a process for validation of claims output against regulatory guidelines. This is a cross-disciplinary effort that requires input from coding, billing, revenue integrity, and compliance at a minimum. Once you can discretely report on a service (e.g. non-COVID pediatric telehealth), outline the requirements for billing, validate claims output, and then begin to release those claims. Reference the latest from CMS and reach out to us if you need help interpreting any of the published guidance; you are not alone in the struggle to navigate the shifting sands of regulations.
  • Uninsured Patients– A significant provision of the FFCRA and CARES acts allows health care providers to seek funding for uninsured patients that required COVID-19 testing or treatment under a COVID-19 diagnosis. The payments for COVID services will be aligned with Medicare rates and apply to approved services provided on or after February 4, 2020. A portal is currently open to determine eligibility and claims were accepted as of May 6, 2020. There are system configuration considerations and patient privacy concerns that your organization should consider when implementing a solution to capitalize on the support available.
  • Patient Portions– As impact to your patient population continues to be a central focus of your follow-up and customer service staff, the shifting employment landscape may result in coverage losses or gaps that will inflate your self-pay receivables. Current financial realities for patients and their families may mean that existing payment arrangements may be at risk. While your financial assistance teams are working to find alternative funding sources, make sure that your customer service processes are aligned as well. Supportive steps include appropriate dunning messages on statements to encourage patient outreach, validation and adjustment of payment plans and payment plan policies, and coaching on how to discuss finances during this challenging period. Take a look at our approach to compassionate collections.
  • Remote Workforce Support– To keep your revenue cycle moving your billing teams need a structure in place that effectively supports their remote work efforts. Management and oversight for a decentralized workforce can be challenging when you have time to plan; during this rapid deployment you will need your management team checking in early and often. Check out our blog posts on productivity monitoring and virtual huddle boards to help you get started.

Thank you for all the work you are doing to mobilize your teams and take care of patients. We will continue to publish relevant content as the pandemic evolves. If you have questions, please contact Spencer Thielmann at The Wilshire Group – Whether or not you are a current client, we have experts available to assist your team with COVID-19 response efforts and questions.

Spencer Thielmann

Vice President, Operations

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