One year later, the COVID-19 pandemic continues to illustrate the ways that innovation has helped revenue cycles weather the storm.
One year ago, when the COVID-19 pandemic upended life as we know it, some revenue cycles were better positioned than others to deal with the demands of the emergency.
"Organizations that had revenue cycle analytics, denial management tools, employees working remotely, and automated check-in processes in place at the beginning of 2020 were perhaps better positioned than other organizations to manage the operational demands of the pandemic," said Paola Turchi.
Turchi, a revenue cycle consultant for Allscripts, is a certified professional coder through AAPC, a fellow healthcare financial professional through HFMA, and a certified medical practice executive through MGMA. She was recently a guest on the HealthLeaders Revenue Cycle Podcast, where she shared her thoughts on how revenue cycle leaders have dealt with the COVID-19 pandemic.
The following conversation has been lightly edited for clarity and length. Listen to the full episode here.
HealthLeaders: I know that in your role with Allscripts you get an inside look at how a broad swath of folks have been dealing with the pandemic over the past year and how it has changed and evolved along the way. Broadly speaking, what are some of the big ways that revenue cycles have changed for the better over the past year?
Paola Turchi: Last year was quite a roller coaster for many organizations but this crazy ride sure brought a lot of opportunities to enhance their revenue cycle processes.
For instance, some organizations implemented online or mobile check-in procedures so patients would not have to interact with their staff members prior to being seen. These tools captured updated patient demographics, new insurance information, and all required copayments and/or out-of-pocket expenses directly from the patient a few days prior to their appointments.
I would say this is big when we are talking about wanting to streamline front office procedures and minimize the time patients spend in the waiting room.
Another area that benefited from this crazy ride was scheduling. Some organizations implemented online and smart scheduling capabilities to help them support and prioritize the backlog of services that were canceled due to the pandemic.
Not only were patients able to reschedule some of these services without having to call the office, but the office was able to prioritize the opening spots to first treat those patients that needed it the most.
I would also say the pandemic has pushed the industry to quickly adopt a new revenue stream with telehealth services. Many organizations were somewhat able to maintain visit levels by supplementing office visits with video conferencing, telephone calls, etc.
It is unknown how these services will be reimbursed in the future once the public health emergency is lifted, but I do believe this type of service delivery model is here to stay.
Finally, I would say the pandemic has accelerated the adoption of processes and technology that support a work-from-home staffing model. Whether this has been a blessing or a curse for some organizations, it really depends on the organization, but it sure has highlighted the possibility of having employees work remotely.
HL: There are new numbers out from the American Hospital Association and Kaufman Hall showing that hospital revenues in 2021 are projected to fall between $53 billion and $122 billion from pre-pandemic levels. Where are some areas that revenue cycle leaders can look to for making up for that lost revenue?
PT: I was [recently] the moderator for a revenue cycle panel at the HFMA South Texas Leadership Forum and the panelists really concentrated on the importance of diversifying their business lines to address the drop of inpatient and ED services.
This is a trend that slowly started a few years ago but it sure has been accelerated by the pandemic. They mentioned the importance of looking at ways to shifting inpatient and ED revenues to other source of income such as outpatient surgery centers, nursing homes, physician alignments, urgent cares, etc.
In regards to revenue cycle processes the effort continues to be focused on making sure organizations are capturing every dollar they are entitled to: they need to closely track denials and pro-actively implement processes to avoid them;, they need to monitor contract adherence to make sure payers are accurately processing payments;, they need to implement processes to make sure all services provided have been captured and billed;, they also need to implement tools to proactively collect from the patients for non-emergent services;, and last but not least, they need to automate back-end processes with robotic process automation and machine learning to timely address all outstanding claims.
HL: How do you see remote staffing and workforces evolving as we move into year two [of the pandemic] and what are some best practices you have seen?
PT: I envision that in year two, many organizations will adopt a hybrid model where some employees and/or roles will remain remote, and some will be brought back into the office.
Organizations in urban settings will perhaps be more likely to keep employees at home, given the fact that they [have] easy access to internet and other commodities that rural facilities struggle with.
I would say a well-run remote workforce tends to have three key components well-aligned: people, process, and technology.
Regarding people: as some organizations continue to navigate their work-from-home options, they need to look at their employees and determine whether they are meant to work remotely or not.
At the beginning of the pandemic many organizations saw an increase in productivity as staff members were excited to have the opportunity to continue working, but now that the fears of unemployment have somewhat subsided, organizations are starting to see a drop in productivity.
Not everyone is fit to work from home. So, in year two is key to identify who will remain at home and who will be brought back into the office.
After evaluating staffing needs, organizations need to make sure they have clearly documented workflows and have published their policies and procedures so they can foster staff autonomy and accountability.
It is key for all employees to know what they need to do, how they need to do it, and when they need to do it. Clear expectations lead to better results.
Organizations also need to be sure that these employees are engaged and have the same opportunities that in-office staff members would have to be recognized and be promoted.
The last piece of the puzzle is technology. Having the right tools for employees to do their job and for the team to timely and effectively communicate and engage will be crucial to be successful.
HL: Self-pay collections are increasingly important, but the pandemic has financially strapped a lot of patients who have lost work or insurance coverage or both.? How can revenue cycle leaders help patients while helping the financial health of their organizations when it comes to self-pay collections?
PT: The big secret to success when it comes to patient collections is being proactive. Take this opportunity to update self-pay policies for uninsured and underinsured patients and consider checking eligibility for every patient at every visit.
Also focus on leveraging technology to facilitate the collection of outstanding balances, such as online and mobile payment capabilities, automated credit card deductions for payment plans, estimation tools, and automated collection letters and phone calls.
Alexandra Wilson Pecci is an editor for HealthLeaders.
Diversify your business lines to address the drop of inpatient and emergency department services.
Identify which employees will remain at home and who will be brought back into the office.
Update self-pay policies for uninsured and underinsured patients and check eligibility for every patient at every visit.