The COVID-19 impact on the revenue cycle for hospitals and other healthcare providers

• Hospitals and other providers should track the COVID-19 impact on revenue cycle processes.
• Notable billing and coding issues may arise from additional use of telehealth and changes to Medicare regulations.
• Changes to patient financial responsibility affect copayments and deductibles, along with referrals.

The impact of the COVID-19 pandemic on the revenue cycle is fluid, but providers must manage it to meet their obligations and missions. Here are key considerations with financial sustainability hanging in the balance.

Billing and coding

Ensure you know what is covered by health plans for both inpatient and outpatient services. With the rules rapidly changing, providers and support staff need to be properly apprised and trained.

Other issues to keep in mind include:

Telehealth. Most outpatient visits have shifted to telehealth visits. This trend requires an understanding of the associated requirements of health plans. Questions to ask include:

• Will the insurance company pay the full rate?
• Is further documentation needed?
• Are approvals needed?

Remote billing work. If you have not already shifted your billing office to remote status, determine whether these key employees can manage billing-and-collection responsibilities from home. This assessment is critical to ensure cash flow issues are minimized.

If the answer is “yes,” organizations should identify:

• Which employees will need remote access
• What systems and equipment those employees need to be productive
• How the plan will be implemented

Also, ensure adherence to regulations regarding the privacy and security of personally identifiable information and other HIPAA provisions.

Emergency preparedness planning. Do you have a business continuity plan? If yes, has it helped ensure your business is as prepared as possible to minimize disruption during this black swan event? If needed, consider updating or developing your plan as soon as possible.

Changes to Medicare regulations. Several Medicare changes have been implemented over the last few weeks. Provider organizations should review these changes and identify any additional services that may be billable, such as treating uninsured patients who have COVID-19 or providing care via telehealth. There also are opportunities to receive accelerated or advance payments from Medicare to increase cash flow amid potential COVID-19 disruptions in claims submission or claims processing.

Patient financial responsibility

The pandemic has led patients to incur significant medical bills that are not covered by their health plan. This shortfall adds to the financial strain on hospitals and other providers. Each organization should evaluate its credit and collection policies during this crisis.

Hospitals also should account for changes in:

Copays and deductibles. Several large health plans have made changes to policies on patient out-of-pocket responsibility. Ensure your registration and billing staff are aware of these changes so that invoicing and collections can continue apace.

Standard referral requirements. Ensure these changes are considered, as they could shift payment obligations from patients to  health plans.

Resource optimization

COVID-19 has placed significant demand on an already overwhelmed healthcare system. Provider organizations should make sure their limited resources are appropriately allocated to meet patient needs.

Specific areas to consider include:

Capacity planning. Ensure you have proactive revenue cycle strategies to meet patient needs in the event there is a surge on existing capacity limits.

Operational accommodations. Consider adjusting hours of operations, staffing and documentation requirements for telehealth visits.

There is still much to be learned as COVID-19 peaks in the U.S., and healthcare organizations will need to adapt under extreme pressure. Staying apprised of changes across the revenue spectrum — from patient to payer to provider — will help hospitals maintain transparency and understand cash flow throughout the crisis.