Five Realistic Steps for Healthcare RCM Improvement During Phase II of COVID-19

According to Definitive Healthcare, hospital revenue losses stand as the biggest healthcare trend across the next year. In continued strategic recovery efforts across the industry, what else can healthcare leaders do to boost finances? Today, let's address five realistic steps for revenue cycle management (RCM) improvement during this next stage of the pandemic.

  1. Get back to the basics.
    Healthcare facility leadership should focus on survival, maintenance and growth— in that order. Organizations need to realistically acknowledge that they cannot jump from survival to growth mode overnight. Concentrate first on operational sustainability. Maintenance and profits (growth) will follow. Once the direction is set and started, business office and RCM teams should proactively identify common barriers that will pop up, and list targeted actions that will eliminate or minimize each one's impact. The initial goal is getting business reignited, not returning "back to normal."
  2. Target past A/R.
    Within this transition, the priority step during this time for hospitals, no matter the location, should be working down past A/R for account services provided pre-COVID-19. By doing this, business office and RCM staff clear out the work backlog for when full patient care services are restored.
  3. Address claims holds.
    A major aspect of working down A/R is resolving claims holds— an unavoidable result of the pandemic. With the emergence of COVID-19 came new CPT codes, diagnosis codes and grouper logic for categorizing and identifying patient care for billing and insurance purposes. Once CMS approved these updates, software vendors had to scramble to distribute and deploy their system updates for that logic across healthcare facilities. The effectiveness of this quick transition rests on the combined efforts of hospital IT and RCM teams for filing claims, pre-testing updates and working to understand how new rules and logic apply to their organizations. Health system business office and IT teams need to work jointly to get regulatory applies rolled out across facilities as soon as possible.
  4. Strategize your plan of attack.
    Communicating effectively with both IT and business office teams, leaders should create a working document with a responsibility matrix. Conduct a weekly meetings around it and cover updates spanning new billing requirements (regs), changes in clinical documentation for billing, technology updates (telemed), summaries of adjustments in the local and national economies, along with new insurance coverage/payer requirements.
  5. Utilize flexible support options.
    COVID-19's impact on balance sheets will push cost reduction efforts. With healthcare facilities struggling with cash-on-hand, downsizing has ultimately been occurring across non-essential areas. On the IT front, hospitals should assess their support partners to ensure they thoroughly document their value and have multi-application expertise for flexibility. Look to agile programs like FlexSourcing, which drives down IT tickets over time to cut operational support costs.

The debt surge will continue to take a hold of the healthcare industry's direction for years to come. There will be no complete return to "normal." In this phase of the pandemic, many hospitals need to flip their approach back to survival basics with their revenue cycles. With the delay of claims processing comes a stall in payouts, directly hindering immediate cash flow. By combining these five realistic steps for RCM improvement, healthcare leadership can get facilities back on track with a nimble, viable approach.

To remain up-to-date on the latest healthcare and health IT industry changes amidst the COVID-19 pandemic, check back to the Mission Critical Change Resource Center.

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