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Getting, Vetting, Disseminating: Keeping Your Revenue Cycle Organized Through COVID-19 Changes

Analysis  |  By Alexandra Wilson Pecci  
   April 09, 2020

Organizations need a "single source of truth" for getting, vetting, and disseminating updates, rather allowing disparate groups of people to act on their own, chase down leads, and possibly communicate incorrect or incomplete information based on whatever they've heard lately.

Everyday there's new information coming from countless sources related to COVID-19 related billing and policy changes, and with things moving so fast, it's tempting to immediately jump on any change in an effort to stay ahead.

But that strategy can backfire, say Maureen Clancy, senior vice president of operations, and Mark Foulke, executive vice president of transformational value-based care for Privia Health in Arlington, Virginia.

"You can't just run with what you hear," Clancy tells HealthLeaders. "You have to slow down a little bit."

Instead, Foulke and Clancy say that organizations need a "single source of truth" for getting, vetting, and disseminating updates, rather allowing disparate groups of people to act on their own, chase down leads, and possibly, communicate incorrect or incomplete information based on whatever they've heard lately.

"Obviously the information is coming fast and furious from the payers and from CMS, and I would say that the most important thing is to have organization," Clancy says. "Have the experts in revenue cycle—whether it's your audit team or your coders and billers—be organized so that information is flowing after being vetted by the right people."

As she adds, "it takes a lot longer to unwind than it does to do it right in the first place."

At Privia that "single source of truth" is its COVID-19 task force, which involves leaders from both the organization's clinical teams, as well as its administrative teams, including:

  • Human resources
  • Communications across all audiences (patients, physicians/providers, employees, etc.)
  • IT
  • Payer contracting
  • Population health/value-based care
  • Revenue cycle
  • Clinical informatics
  • Customer support
  • Legal/compliance
  • Public relations & advocacy

Without that single source of truth, "you can spend a significant amount of time chasing different tangents," Foulke says. "In something that's changing as quickly as this, it's very good advice to have people thinking about hitting pause buttons and thinking about structure."

Getting the information

There's no dearth of COVID-19 information out there. The question is, where is it coming from?

Things mentioned during President Trump's daily COVID-19 briefing, for instance, likely don’t include the "fine print" of a new rule or policy.

"Until it becomes published by CMS and we know the effective date and we know exactly the specifics, we can't just act on that," Clancy says.

That's why she says—specifically its COVID-19 pages—is the first source for information for revenue cycles. From there, she says, sources should include payer websites and emails and "lastly payer phone calls" because their telephone availability may be spotty during the crisis.

While commercial payers typically follow CMS's lead, that's not always the case, and it's crucial to have ongoing communications to verify changes. Sometimes their policies may vary. Foulke recalls recent communications he had with two large payers, which differed on how they would deal with place-of-service changes for telehealth billing.

"We are having discussions with payers a lot; some of the payers are even confused," he says. "Payers, just like everybody else in the world, are reacting to this very sudden change."

Vetting the information

Once information is gathered from reliable sources, it needs to "funneled" to the right people, whose teams can take the lead in vetting, says Foulke. A change that impacts coding will be funneled to the VP of audit and coding for vetting, and if needed, may be forwarded to the leader of the payer team as well.

"This is where organization and cool heads prevail. We know whose swim lane this is in [and] it will go to that person," Clancy says.

It’s also important to strictly stick to that structure once it's in place, she says.

Foulke also notes that organizations should look to their advocacy groups for help and guidance. For Privia—a national physician-led medical group with more than 2,500 providers in five states and the District of Columbia, 2.6 Million patients, and 660 care center locations—those advocacy groups include ones like the Medical Group Management Association, American Medical Group Association, and America's Physician Groups.

"They are a very good way to have a fulcrum or a centralized point for understanding the communication with government and payers to help advocate clearly for us," he says.

Disseminating the information

Once a new piece of information is gathered and vetted, it will be disseminated by Privia's single source of truth: Members of its coronavirus task force.

"Make sure you have that centralized communication tool otherwise you will chase a lot of windmills," Foulke says.

Rather than tracking changes in a format like a Microsoft Word document, the Privia team communicates online, using a digital, cloud-based system where real-time updates can be tracked and time stamped.

This allows for faster and more efficient communication, since everyone, including those who are sheltered in place and working remotely, can have immediate access to the latest information.

Privia has had a task force structure ready to go for a long time and has used similar ones during Hurricane Harvey and other recent natural disasters. However, Clancy says organizations without one can still benefit from creating one now.

"Having that structure in place to start with is key," she says. "For those that don't have it, it's not too late. They can certainly set this up."

Alexandra Wilson Pecci is an editor for HealthLeaders.

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