Five Realistic Steps for Hospital RCM Improvement During COVID-19: Part II

According to Definitive Healthcare's Healthcare Trends Survey, hospital revenue losses stand as the biggest trend for the next year. As the country moves intothe next phase of the pandemic, with so much volatility, it has been hard for facilities to solidify financial footing. As a continuation from our previous post, utilize these five additional steps for healthcare revenue cycle management (RCM) improvement during COVID-19, starting with regulatory considerations.

  1. Regulatory updates
    From a claims management stance, keep up with changes in regulatory updates as CMS rapidly pushes the American Medical Association (AMA) to create new current procedural terminology (CPT) codes in relation to COVID-19, which didn’t previously exist. If not, healthcare providers run the risk of not being reimbursed to the full potential. Because of these regulatory updates, some health systems are having to recalculate hundreds of thousands of processed patient care claims in order have a more accurate projection of estimated revenue. This all compiles into tactics to keep the organization more financially sound to more accurately predict how much money is coming in each month.

  2. Coding documentation alignment
    Though often overlooked, a coding assessment of patient visit documentation is vital. Chart documentation accuracy for coding of care for each patient visit is even more critical currently because most providers may not be seeing as many patients now as during the same time period last year. Providers cannot run the risk of downcoding a visit. Clinicians should make sure the actual visit matches the level of documentation code. Clinicians, especially new staff, may need coaching and individual assessments on chart documentation to substantiate a higher-level CPT code to ensure higher, more accurate reimbursement for patient visits. Rushed, lacking and minimal documentation can lead to downcoding error when every little amount of claims reimbursement matters.

  3. Telehealth coordination with front-end processes
    Take advantage of telehealth’s efficiency differentiators. Many health systems are more effectively using provider time by booking back-to-back virtual visits, getting more appointments in for a given day. Telehealth also eliminates patient care lag traditionally experienced with rooming patients and sanitizing the room, even prior to COVID-19 standards. With telehealth, movement of the patient is eliminated, so providers can get straight to addressing the patient care plan. As noted in CHIME sessions, organizations are also seeing a decline in patient no-show volume because of both convenience and visit reminder effectiveness in the virtual connected care format.

  4. Patient portal best practices
    Facility leadership should encourage providers to continue to strategically utilize the patient portal for as much pre-visit and post-visit documentation and exchange as possible. Efforts shouldn’t stop with the clinicians. Push for portal utilization for patient payments. Keep up with patient care adherence alerts like flu shot reminders. Utilize the portal and coordinated email to distribute updates regarding health system COVID-19 regulation changes, especially when in-person facilities reopen or adjust hours, so patients see visual reinforcement that it’s safe to return to in-person care. The same approach can be applied for communicating COVID-19 vaccination plan updates, so patients maintain trust and reassurance with the health system.

  5. Wellness appointment catch up
    Healthcare organizations should focus on low hanging fruit, like catching up on annual wellness visits and comprehensive health risk assessments, now that most health plans provide reimbursement for virtual annual wellness visits. A portion of this tactic requires emphasis on patient education in telehealth processes, as health systems plan to increase senior citizen utilization in local markets to overcome preventative care disruption.

By combining these five best practices with the previous RCM steps, healthcare organizations can begin to climb back from this year’s significant cash flow blows.

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