As the U.S. healthcare system faces relentless financial strain, healthcare revenue cycle leaders are seeking strategies to increase patient volume and mitigate revenue loss during COVID-19.
According to an AHA report, hospitals and health systems report average declines of 19.5 percent in inpatient volume and 34.5 percent in outpatient volume relative to baseline levels. In addition to financial struggles caused by volume loss, the recently released 2021 Physician Fee Schedule Proposed Rule means significant revenue loss in the Medicare fee schedule for those who are not primary physicians—an indication of even greater loss in 2021. Budget neutrality requirements mean that the proposed increases for some providers would be offset by reducing the conversion factor for everyone else by 10.6%.
Given the current financial outlook, CFOs must prepare for a second-round hit to revenue, as well as loss of patient volume. A recent HFMA webinar, “Mitigate the Impact of Volume Loss by Optimizing the AR You Have,” presents practical strategies for responding to the financial challenges exacerbated by the pandemic. These include best practices for insurance discovery, effective self-pay strategies, and solutions for near-end, stale AR.
Insurance Discovery and Verification
Many facilities rely on manual, labor-intensive insurance verification processes that lack the ability to yield complete, accurate results. Insurance discovery is especially helpful in the COVID-19 environment with telehealth adoption and a higher occurrence of incomplete demographic and insurance information. Today’s technology tools can reap a 40 percent insurance discovery rate in your uninsured population, opening a path to optimal reimbursement.
Deductible monitoring. Proactively monitoring and managing deductible fulfillment can have a positive impact on cash flow, particularly in your on-demand population—urgent care, emergency department, and unscheduled surgery. By dropping the claim after the deductible has been filled, a provider reduces AR aging and realizes higher collection rates.
Charity care and adaptive financial assistance (AFA). The main premise of AFA is that patients do not pay when financial assistance is insufficient. However, if financial assistance is targeted to patients’ circumstances, they will likely pay in full, which helps providers achieve optimal revenue.
HRSA COVID-19 Uninsured Program. This option is an opportunity to submit a claim to a government program and receive reimbursement at the Medicare rate. However, best practice is to verify a patient’s uninsured status through an insurance discovery tool prior to moving forward because the program is intended for patients who are truly uninsured. Once a claim is submitted, you have no opportunity to appeal or bill the patient if the claim is denied or underpaid. Also, taking the time to register and submit claims will result in additional revenue.
AR and Collections Opportunities
AR and collections opportunities require best practices and dedicated work to monitor follow-through and measure outcomes. Begin by automating your claims status checks, alongside a partner that can provide insurance verification and deductible monitoring. Additionally, establish an effective appeals process managed by highly trained staff.
For optimal revenue results, it is important to monitor payment disallowance ratios by financial class. Monitor aging AR and denial reporting, and consider using a financial analyst to identify and track trends. This practice can reveal early in the process when payers have made changes and enacted new coding or denial policies. Then you can negotiate with payers, adapt to changes, and recoup dollars.
Proactive Volume Strategies
COVID-19 media coverage has affected patient behavior since the outbreak of the pandemic. At one northwestern health system, the volume of heart attack patients fell by about 50 percent in March 2020 compared with the same month last year. Others have reported similar numbers as people are staying at home in fear of contracting COVID-19. Restoring patient volume is a gradual process that requires effective patient engagement practices to counteract patient behavior.
An aggressive marketing campaign that encourages people to come in for routine care as well as critical care to manage chronic conditions can increase volume by 20 percent. Educate patients on safe options for seeking emergency care—demonstrate your commitment to earn their trust and protect their health. These measures increase patient satisfaction, decrease patient leakage, and capture new revenue.
About the Author
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 is the Director of Strategic Partnerships for ZOLL Data Systems. She 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.