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Organizations combating the COVID-19 pandemic are facing significant pressure, much of which is financial. Most pressing are shortfalls in cash flow as a result of decreased revenues from deferral of elective services, mounting expenses due to emergency testing and services, and increases in treatment of uninsured patients.

The revenue cycle is an asset that organizations can use to improve cash flow and provide financial relief as they navigate the challenges of COVID-19.

Every organization’s circumstances and outlook will be different. After an evaluation of current issues, the following revenue cycle strategies can immediately accelerate cash to provide financial relief: reimbursement levers, vendor opportunities, accounts receivable, and process and policy updates.

Reimbursement Levers

Organizations can take specific action with commercial and government payors to increase and streamline reimbursement in the short term.

Consider the following recommendations:

• Accelerate Medicare payments based on historical payments.
• Work with state authorities to obtain waivers for Medicaid patients (authorization requirements, provider enrollment, appeal timeframes, etc.).
• Negotiate with major commercial payors to relax requirements (denial appeal timelines, timely filing forgiveness).
• Request advanced or standard monthly payments from major commercial payors based on historical volumes and payments.
• Track payment advances for future reconciliation.
• Suspend contract performance measures with payors for the year based on staffing shortages and Centers for Disease Control and Prevention (CDC)-recommended cancellations.
• Bill for telehealth services and new providers as normal, in-network services.

Vendor Opportunities

Vendor relationships provide opportunities for expense relief by increasing vendor utilization if capacity is strained or reducing vendor utilization if excess capacity is an issue.

Consider the following recommendations:

• Negotiate rate reductions or delayed payments with existing vendors, using volumes and placements as leverage.
• Modify outsourcing thresholds to maximize internal resource utilization and reduce vendor expenses.
• Seek opportunities to sell bad debt or conduct zero balance reviews as additional revenue sources.

Accounts Receivable

Staff shortages, a virtual workforce, decreased elective volumes and changing accounts receivable profiles require organizations to revisit their accounts receivable strategy to maximize collections.

Consider the following recommendations:

• Update the charge description master (CDM) with new COVID-19 testing and treatment codes; set up billing edits to automatically add necessary modifiers.
• Use the health information system (HIS) to flag, monitor and report on COVID-19-related cases for quicker payment resolution and settlement, and monitor cases closely for reimbursement.
• Establish monitoring and feedback pathways to registration staff and clinicians to ensure patient demographic and clinical care is appropriately documented for newly created tests and services (telemedicine expansion).
• Cross-train staff to work with multiple payors, services and functions, allowing for additional flexibility as volumes shift.
• Maximize available resources by prioritizing activities with the highest return on investment, including a focus on accounts with approaching timely filing deadlines, those with highest dollar balances, special projects and batching opportunities.
• Identify opportunities to group accounts for a settlement or batch adjudication.

Process and Policy Updates

As the crisis evolves and situations change quickly, alleviate potential revenue loss by continually evaluating and updating policies and procedures.

Consider the following recommendations:

• Establish a regulatory work group to review new policies and regulations from the Centers for Medicare & Medicaid Services (CMS) and state/local governments, ensuring adherence to billing guidelines and criteria necessary to obtain stimulus relief funds.
• Create a central webpage to share the latest updates, information and training materials with staff.
• Communicate eligibility and authorization requirement updates to patient access staff, and rerun automated eligibility determinations as patient employment status is changing frequently.
• Track providers who have not been credentialed or enrolled to ensure payments are received; services provided by these providers should be billed as normal.
• Track postponed elective services using a flag in the HIS, allowing for easier rescheduling once operations resume.

For more information, contact us or visit our COVID-19 resources page, including the Huron Stimulus Relief Gateway.