While the societal and economic effects of COVID-19 have become increasingly clear for countries around the globe, healthcare systems and physicians are having to adapt under extreme pressure. The outbreak is a human tragedy, above all else, affecting millions of people around the world. Companies across every industry imaginable have had to face unsettling changes as the world adjusts to the threat of COVID-19 but, not surprisingly, healthcare has been one of the hardest hit sectors. The effect of the global pandemic is predicted to go far beyond the disease itself as healthcare systems rapidly adjust to anticipate what the “new normal” will look like. Here are some of the key considerations in the evolving situations and major implications for healthcare providers and their revenue cycle.
Canceled Elective Surgeries
Organizations that provide treatments and devices associated with non-urgent surgeries have already had to pause elective surgeries in order to deal with emergency care for COVID-19 treatment as well as dedicating space to control contagion in medical facilities. Elective cases are the primary source of revenue for many specialists, ambulatory surgical centers (ASCs), and hospitals, allowing them to take a loss on certain other services while remaining profitable. At large, facilities have already lost significant revenue due to these delays and it is projected that many patients will not follow through on elective surgeries in the near future, if at all. Healthcare organizations are already managing large reductions in demand for office visits. Furthermore, even if patients do follow through with elective procedures, healthcare systems will have to deal with delays in reimbursement due to reduced administrative capacity, and lack of liquidity as payments are largely diverted to cover COVID-19 treatments.
The CARES Act funding will help offset these losses somewhat, but for how much remains to be seen by the time healthcare organizations cover the expenses with COVID-19-related surge capacity and the lost revenue for however long elective procedures must be delayed.
With routine appointments that couldn’t be converted to telehealth visits being pushed as long as six weeks out, appointment volume has been drastically cut for many healthcare organizations. Nurses, doctors, and other healthcare staff will be facing layoffs due to the large decrease in in-office patient visits. Many of these visits are canceled due to patients being scared of being exposed to COVID-19 when visiting their physician. Vital treatments are being ignored or delayed because of patient or physician fear, which is causing many other health complications. While canceling appointments may seem like a necessary part of social distancing, it is harming our health and physician’s businesses. After being asked to risk their lives by working on the front lines of the pandemic, medical professionals will also have to weather the storm of layoffs, lost pay, lost health insurance, and facility closures for months, if not years, to come.
Telehealth and Technology Implementation
The use of telemedicine for direct patient care became a central strategy for both reducing patient & physician exposure and surge control for patients suspected with COVID-19. Luckily CMS and other payers changed their telehealth reimbursement strategies to make sustaining seeing patients possible. Hopefully, going forward, telehealth looks like this will be a trend that will persist in healthcare. Offering personalized and consistent care by using a digital first approach is likely to change the healthcare landscape drastically. It will mean providers and organizations will have to devote significant time and resources to adopting these new technologies and staying agile enough to keep up with changes to come. After the COVID-19 pandemic, organizations are going to want to look into tighter integration and smoother workflows since many rushed their implementations.
Revenue Cycle Billing and Coding for COVID-19
With the rules rapidly changing, COVID-19 is forcing revenue cycle teams to need to be adequately educated and trained on what is newly covered by payers in terms of copays and specific services. This includes coverage and documentation of new practices, such as telehealth and COVID-19 testing. Organizations will also need to address remote billing workflows and oversight management as more employees are working from home. Training is crucial to keep up with the rapid changes being made to Medicare regulations – there have already been several implemented, and provider organizations should be prepared for more.
Patient Financial Responsibility
Healthcare providers are already struggling to optimize collection strategies in a complex world of medical billing. Doing so in response to a global health crisis seems like a daunting task. The pandemic and the need for emergency care across the country has led patients to incur large medical bills that, at times, aren’t covered by their health plan. In addition to this, specific services are fully covered by payers now without copays. Out of network providers will not be able to seek to collect from a patient anything greater than they would pay for an in-network provider. These policy changes add to the administrative burdens on providers and organizations to make changes to credit and collection policies.
Allocating Appropriate Resources to Meet COVID-19 Revenue Cycle Needs
COVID-19’s demand on the healthcare system has overburdened organizations around the world. This results in shortages on staff, space, and supplies, which can have a negative impact on patient outcomes, according to the National Academy of Medicine. Providers and organizations will also need to make sure that they are able to meet patient needs despite the drain on resources in the wake of COVID-19. This includes possibly adjusting hours of operation, staffing, and documentation requirements for telehealth visits, proactive revenue cycle strategies, and ensuring the cost to replenish PPE and other diminished supplies is factored into budgets and strategies.
The federal stimulus bill, known as the Coronavirus Aid, Relief, and Economic Security (CARES) Act, includes $100 billion to cushion the economic blow to healthcare providers. It also boosts reimbursements by 20 percent for treating Medicare patients with COVID-19. The bill has other provisions for Medicare, such as eliminating a bulk of scheduled payment reductions, advancing payments, and temporarily removing a 2 percent sequestration amount for treating Medicare patients.
A COVID-19 Revenue Cycle Plan
Healthcare systems are so far doing an incredible job of responding to patient needs in the face of this global crisis. Facing impossible tasks like seeking places to treat overflow patients, acquiring diagnostic tests, identifying and protecting staff, providers and organizations are already having to pivot in order to prepare for the myriad ways they will have to adapt to new care models and alleviate the revenue cycle obstacles presented by COVID-19.
It is essential to have a strategy for how to keep revenue coming into your office despite all the challenges the COVID-19 pandemic is having on your revenue cycle. TempDev revenue cycle consultants have worked with many organizations to develop a strategy that keeps money flowing during the economic downturn. Contact us now to begin developing your strategic plan.