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4 Ways COVID-19 Reshaped the Revenue Cycle

Analysis  |  By Alexandra Wilson Pecci  
   December 28, 2020

Everything is different than it was a year ago. Here's a look at our "new normal."

In mid-March, COVID-19 reshaped almost everything about our world overnight, and the revenue cycle wasn't spared. Entire departments were rapidly deployed to work from home, volumes plummeted, billing got pushed to the backburner, and the demand for digital tools ramped up.

Here's a look at four ways the pandemic has reshaped the revenue cycle.

Remote work becomes the norm

Only a year ago, many revenue cycle leaders believed work-at-home myths, such as lost productivity and an inability to perform certain tasks remotely.

This year changed all that when entire departments were deployed within days to work from home.

Among them was ProMedica. Before the crisis, about 25% of ProMedica's revenue cycle employees worked from home, and most of those worked in the middle revenue cycle. However, within just a couple of weeks, 95% of ProMedica's revenue cycle were moved to home offices.

Months later, many revenue cycle teams remain working from home, with leaders questioning whether certain roles will ever return to the office. At first, the focus was on staff productivity, but as the months wore on, many leaders recognized that they really needed to be lasered in on effectiveness.

Data analytics has helped Memorial Health System do that more effectively with its remote workforce.

"We can now track staff effectiveness at the individual or team level, at the account level, by the hour, and by the payer," said Derek Dudley, senior director of revenue cycle. "I can see how long it takes a user to resolve a task, and I can see by hour how much cash they're bringing in."


Why Remote Revenue Cycle Success Depends on Data Analytics

Remote Revenue Cycle: Will it Ever Return to the Office?

ProMedica Leader Shares Rapid Work-At-Home Migration Response

Digital health goes mainstream

One of the first signs that the COVID-19 pandemic was unlike anything else we'd ever experienced was when CMS announced in March that it would widely reimburse for telehealth services during the public health emergency (PHE).

Now, Medicare has made permanent nine telehealth services and will extend payments for another 59 services beyond the public health emergency in the ongoing effort to expand remote healthcare access in rural America.

CMS has also commissioned a study to examine the efficacy of the remaining 76 telehealth services added during the PHE, Verma said.

Other entities have been moving to expand or make permanent telehealth reimbursement, including states and payers, as telehealth visits skyrocket.

Telehealth isn't the only way that the digital experience has reached healthcare consumers during the pandemic. From opening the so-called "digital front door" to wanting online appointment-making and bill-pay tools, patients want their healthcare experience to be as easy and high-tech as their experience with other industries.


CMS Makes Permanent Some Telehealth Services

Picturing Telehealth in a Post-Pandemic World

4 States Band Together for Telehealth Effort

Idaho Moves to Permanently Loosen Telehealth Rules

How COVID-19 Kicked Open the Digital Front Door at Memorial Health System

Patients Want Digital Access Across the Care Continuum

Volumes plummet

In the early days of the pandemic, normal life ground to a halt for hospitals as they were forced to postpone elective procedures and close clinics.

Although most patients are now allowed back, visit volumes still haven't fully recovered. For instance, after experiencing some post-COVID-19 rebound, hospital visit volumes recoveries remained stagnant at the end of fall 2020, according to TransUnion Healthcare research.

The analysis of more than 500 hospitals across the United States found that inpatient volumes were down 9% below pre-COVID-19 volumes during the week of October 25-31, which is also one-basis point lower than the level recorded in mid-August.

The analysis also showed that emergency department visits were down 26% compared to pre-COVID-19 volumes, which is only one-basis point lower than ED volumes 10 weeks prior.

Those up-and-down volumes had other revenue cycle effects.

For instance, uneven claim volumes was the top COVID-19 related problem plaguing revenue cycles, according to a survey commissioned by Alpha Health and conducted through the Healthcare Financial Management Association's Pulse Survey program among 587 chief financial officers and revenue cycle leaders at hospitals and health systems.

The most common issue—cited by 50.5% of respondents—was that work and claim volumes were erratic and unpredictable.


ED Volumes Remain 26% Below Pre- COVID-19 Levels

Claim Volumes, Staffing Issues Plague Rev Cycle During COVID-19

ED Volume Recoveries are Sluggish. That Might Not Be a Bad Thing.

Billing takes a hit

Patient billing took a hit during the COVID-19 pandemic on both the provider and patient side.

In an effort to ease patients' financial pain, many providers halted collections during the early days of the pandemic. In addition, as a condition for receiving money from the CARES Act Provider Relief Fund, providers were "obligated to abstain from 'balance billing' any patient for COVID-related treatment," according to HHS guidance.

Washington State took a similar, additional step with an emergency order from the state's insurance commissioner, Mike Kreidler, which banned surprise billing related to COVID-19 lab testing.

Patients have been struggling to pay their bills even without such stopgap measures, though, as millions lost employment and insurance coverage during the pandemic.

Other data shows the ripple effect this has on the revenue cycle: More than half of the families that lost work because of the pandemic also avoided healthcare. In addition, total patient payments declined 47% between March and May.


COVID-19 Will Result in an Estimated 35M Uninsured by End of 2020

Almost Half of Families That Lost Work Due to COVID-19 Also Avoided Healthcare

Washington State Emergency Order Bans Surprise Lab Billing for COVID-19

Total Patient Payments Declined 47% Between March and May

Alexandra Wilson Pecci is an editor for HealthLeaders.

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