Physician revenue cycle management considerations during and beyond COVID-19

COVID-19 has brought unimaginable financial concerns to physician practices across the nation. Virtually all medical practice leaders report experiencing a negative financial impact, accompanied by a 55% decrease in revenue and 60% decrease in patient volume on average since the beginning of the crisis, per an MGMA survey.¹ These challenges are more accentuated in specialty surgical practices where elective surgeries, which they were forced to cancel, constitute most of their revenue.

This drastic drop in revenue and patient volumes has forced medical practices to furlough or lay off staff. By April 8, 48% of the practices have had to furlough their staff and 22% had let some of their employees go, And it is projected that these numbers will increase to 60% and 36% respectively by May 8.²

The federal government attempted to support medical practices with programs such as:

1. The Public Health and Social Services Emergency Fund,³ to reimburse eligible healthcare providers for healthcare related expenses or lost revenue linked to COVID-19
2. The Centers for Medicare & Medicaid Services (CMS) Advance Payment Program (APP),⁴ which offered accelerated cash flow up to a 100% of the physician’s Medicare payment amount based on a three-month lookback period
3. The Employee Retention Credit, which allows eligible providers to claim a refundable payroll tax credit for 50% of qualified wages paid to employees after March 12, 2020, and before Jan. 1, 2021 (with a maximum credit of $5,000 per employee)
4. The opportunity to defer paying the employer portion of certain payroll taxes through Dec. 31, 2020
5. The Small Business Administration (SBA) Paycheck Protection Program (PPP), to help employers retain employees at their current pay.

A lot of the financial and operational consequences of COVID-19 are completely out of our control and it is still uncertain when we will get back normal. Revenue cycle leaders still can focus on the following four areas to help the organization stay afloat and prepare for a possible second wave in the fall.       

Coding

One of the silver linings of this pandemic is the rapid adoption of telehealth tools to help healthcare providers deliver patient care. Telehealth has both helped minimize COVID-19 exposure to patients seeking non-COVID-19 care and provided a new source of revenue for physicians who were not using these platforms and/or were not allowed to bill for it.

Billing requirements have been eased with regulatory waivers authorized via the Coronavirus Preparedness and Response Supplemental Appropriations Act, which includes a provision to allow patients to receive telehealth services at their home.

• Find CMS’ information on waivers for health care providers here.
• Read MGMA’s analysis of Medicare telehealth/telemedicine waivers here.

When it comes to coding and leveraging every dollar available to bill, practices need to clearly understand all the requirements listed under telehealth services, which includes virtual check-ins, online digital E/M, online assessments, remote patient monitoring (RPM) and telephone calls.  It is also crucial to follow all guidelines to code COVID-19 related services. Both MGMA and AMA have great resources available that help organizations navigate all the different scenarios.

• AMA COVID-19 coding and guidance
• MGMA COVID-19 coding cheatsheet

A/R management

Although it is financially challenging to keep the business office running during this time, it is key that practices work on maintaining a streamlined revenue cycle that focuses on patient collections, tight denial management and follow-up automation.  

Massive layoffs, as we are seeing today and will continue to see during this pandemic, will bring a shift in most practices’ payer mix and highlights the importance of checking eligibility every time the patients come in. It also highlights the need to have automated processes to facilitate the collection of outstanding balances: online and mobile payment capabilities, automated credit card deductions for payment plans, estimation tools, and automated collection letters and calls. These are a few examples of key processes organizations need to have in place in order to collect as much revenue as possible.

Every time practices start using new diagnosis and procedure codes, we should anticipate an influx of denials due to coding errors. Leverage your denial management tool to detect these denials as quickly as possible. The goal should be to implement processes to enhance documentation and to configure coding rules within your practice management system to capture and automatically correct possible errors before the claims are billed out.

During this time when practices have fewer resources to manage follow-up efforts, and now that many staff happen to be working from home for the first time, it is crucial to have the tools to:

• Automatically route outstanding claims to specific queues based on claim status and denial reasons
• Automate 277 transaction messages back into the practice management system to easily identify the status of the claims
• Automate the first outreach efforts by configuring bots so users don’t have to manually check the payer’s website to identify if the claims have been paid
• Leverage your analytics tool to track staff productivity.

Managing schedule volumes

Once stay-home orders are lifted and it is safe to reschedule patients who have been postponing care, it is essential that practices leverage technology to automatically prioritize urgent visits which align with the patients’ needs and practice goals. The first-come/first-served approach will lead to no-shows taking over potential spots for patients. Consider utilizing tools which use predictive analytics to highlight high-need visits, reduce no-shows and cancellations, and increase resource utilization. 

Proofing the practice for a potential second wave

With the looming risk of a second COVID-19 wave expected in the fall, it is key for organizations to implement an infrastructure which supports a high-performing revenue cycle and can be managed remotely. Evaluating the following components to formulate strategies for the future is a must to minimize practice disruption:

• Can your employees securely and reliably access your revenue cycle tools remotely?
• Can you securely and efficiently assign work to your teleworking team members?
• Can you automate current paper-based processes?
• Do you have documented policies and procedures for all revenue cycle activities?
• Can you easily track staff productivity and leverage tools to promote communication and collaboration?
• Do you have access to analytics tools to trend key performance indicators?
• Could you leverage a partnership with a third-party vendor that has already stablished processes to support high performing outcomes? 

These are unprecedented times, and many practices are managing unimaginable emotional, operational and financial challenges. This crisis will pass, and those nimble enough to adapt to new opportunities will be in a better position to ride future waves.

Additional resources:

• Revenue Cycle Management: Don't Get Lost in The Financial Maze
• MGMA analysis: Financial assistance for medical groups under 500 employees
• MGMA analysis: Financial assistance for medical groups of all sizes
• MGMA COVID-19 Federal Assistance and Advocacy Center — Regulatory and legislative updates from MGMA Government Affairs
• MGMA COVID-19 Recovery Center — Operational tools and resources, webinars, podcasts and articles on responding to COVID-19

Notes:

1. MGMA. COVID-19 Financial Impact on Medical Practices. April 10, 2020. Available from: mgma.com/covid-fin-impacts.
2. Ibid.
3. “Updates on the CARES Act Public Health and Social Service Emergency Fund.” U.S. House of Representatives Coronvavirus Bulletin. April 22, 2020. Available from: bit.ly/2VYwxcI.
4. CMS. “Fact Sheet: Expansion of the Accelerated and Advance Payment Program for Providers and Suppliers During COVID-19 Emergency.” Available from: go.cms.gov/2Y8F93r.