Unanticipated situations like the COVID-19 crisis present significant revenue challenges for healthcare providers. The path forward can be ...
Juli Forde | May 21, 2020
Unanticipated situations like the COVID-19 crisis present significant revenue challenges for healthcare providers. The path forward can be unclear and confusing as providers seek innovative ways to take care of patients’ clinical needs and receive proper reimbursement. During a pandemic or other disaster, normal best practices may be abandoned in the transitional storm of the crisis. Health systems can be left with enormous operational costs. To address these challenges, many billing teams are implementing new technologies to support revenue capture in today’s unprecedented time of uncertainty.
Hospitals, EMS, and Emergency Medicine Groups are dealing with difficult decisions to remain operational given the steady rise in administrative and staffing costs related to the coronavirus. For example, they must cover the costs of quarantined staff, while bringing in temporary providers to care for patients. Furthermore, moving providers to places experiencing increased demand requires additional funds—travel, housing, personal protective equipment (PPE), education, and training. Other specialties are struggling with the costs associated with rapid implementation of a telemedicine platform. To sustain operations, some providers and hospitals are taking on more debt during this temporary situation.
At the same time, claims processing poses greater financial risk than usual. New ICD-10 codes, new diagnosis codes, and changing regulations have come into play in a rapid-fire time frame. Billing software has standard built-in paradigms that must be rewritten to avoid errors. Though some payers have a policy on their website stating they will waive the patient's cost sharing, the system may not be set up to process claims accordingly. Every phase of the encounter and the claim is more difficult and less efficient. In a crisis, the process is temporarily a broken cycle, lacking proper education, training, and time required to effectively make adjustments, further contributing to revenue loss.
The impact on revenue cycle is profound in several ways including volume, patient responsibility, and the ability to collect patient information. The healthcare industry is experiencing an overall estimated 30% volume drop. However, the drop for emergency departments and urgent care is as much as 80% and 95% respectively. Cash flow is down substantially, with fewer people coming through the door. And in many cases, economic challenges have made it more difficult for patients to pay for the care they receive.
Unfortunately, providers and hospitals have little ability to influence patient volumes during a pandemic. They can, however, take steps to maximize their opportunity to appropriately capture the revenue associated with the care they provide.
Aged AR. Make the most of additional denial, appeal, and collections efforts. The immediate drop in volume associated with COVID-19 allows time for billers to mine past AR. Now is an ideal time to implement best practices and optimize your workflow.
Coding. Take advantage of the decrease in daily coding volume to train and educate coders, particularly on the newest ICD-10 codes and payer-specific coding policies. Ensure that appropriate modifiers and diagnosis codes are being used on COVID-19 claims as applicable.
Verify Uninsured Status. Use an insurance discovery tool to ensure that your uninsured claims are truly without coverage. Often, up to 40% of patients who have not provided their insurance information may have billable coverage. Once verified, take advantage of the HRSA COVID-19 Uninsured Program for those patients who do not have coverage.
To relieve financial pressures and guard against revenue loss, providers are increasingly implementing technology solutions that help ensure accurate and efficient revenue capture. Here are three ways hospital and EMS billing services can improve revenue capture and reduce the patient financial burden.
Patient data validation. Software tools automate the patient data validation process to ensure information is accurate and intact to support billing and avoid claim denials downstream.
Insurance validation and discovery. These tools enable billers to easily identify primary and secondary insurance coverage, including Medicaid. Automated updates related to payer coverage support claim accuracy and reduce processing time.
Patient propensity to pay analysis. Self-pay analytics tools enable billing teams to determine which patients are able to pay, as well as those who may qualify for financial assistance or Medicaid. With this insight, billers efficiently develop payment plans for patients who are able to meet payment requirements, and distribute charitable care programs that are compliant and maintain a patient’s dignity.
The ZOLL® AR Boost™ solution supports the efforts of billing teams to address challenges related to capturing patient information and payment sources, especially during this time of crisis faced by the healthcare workforce. Learn more about how it can help you optimize your AR right now.
Juli Forde is a passionate advocate for those who deliver lifesaving care. Throughout her career, she has been involved in numerous initiatives to assist the specialty of emergency medicine in navigating the complex challenges of bad payer behavior, increased regulation, and unfunded mandates. Juli’s career in emergency medicine reimbursement began more than twenty years ago as Practice Administrator for a large multi-site emergency physician group in North Texas. Juli was a founder of and served as Senior Vice President of Operations for Nicka and Associates. Juli pairs coding and compliance expertise with innovative insights into emerging reimbursement models and post discharge care opportunities. Most recently, she has served as the Chief Marketing Officer for Gryphon Healthcare and President of Rev4ward. Today, Juli serves as Director of Strategic Partnerships for ZOLL Data Systems. Juli has served on committees for the American College of Emergency Physicians (ACEP), the Emergency Department Practice Management Association (EDPMA), and the Urgent Care Association (UCA). She is currently a member of the Board of Directors of EDPMA and is one of a select few non-physician members of the ACEP Coding and Nomenclature Committee. Juli is a nationally known speaker on emergency medicine coding and reimbursement issues. Her speaking engagements include the National Association for Freestanding Emergency Center's annual conference, EDPMA’s Solutions Summit, and ACEP’s Scientific Assembly. Throughout her career, Juli has educated hundreds of providers through speaking engagements, webinars, and personal coaching sessions. Juli is a proud graduate of the University of Texas and lives in McKinney, Texas with her daughters Bethany and Abigail. In addition to her professional endeavors, Juli serves on the board of an equine therapeutic non-profit serving special needs children, and as a volunteer judge and business coach for students participating in DECA. On the weekends, you will find Juli kayaking, hiking, or outdoors listening to live music.
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