By Craig Adkins, Vice President Revenue Cycle Management, AdvancedMD
Twitter: @advancedmd
The past few months of the pandemic have brought many challenges to physician practices, especially small, independent providers operating outside the domains of COVID-19 treatment. While mandatory shutdowns and quarantines have slowed the spread of the virus, the economic impact has been substantial. Fewer outpatient visits—and even fewer procedures—over the past several months have led to serious financial hardship for many providers.
Practices that will stay afloat during this challenging time are doing so strategically. In some cases, practices planned for a “rainy day” and had enough cash in reserve to keep their practices running. Many are also capitalizing on telehealth services, reconfiguring staffing and scheduling hours, and making revenue cycle management improvements to optimize collections performance.
Prepare to capture an eventual surge in patient volume.
During the pandemic shutdown that is continuing to certain extent in some areas, patients with non-emergency conditions (and some with emergency conditions) postponed treatment, either by choice or because practices temporarily closed or limited patient visits. Most of these patients still need medical treatment so at some point there will be a surge in patient treatment demand.
In many areas of the U.S., outpatient volume is already trending upward so practices should begin now to analyze the level of patient volume needed, over the next few months, to recover their financial losses. This analysis will drive important decisions about future staffing and hours for providers and office staff. Returning to 100% of pre-COVID-19 visit volume will not be adequate to recover lost revenue. Practices will need to plan and think creatively about ways to capture as much patient volume as possible.
Here’s a closer look at some strategies for accomplishing this:
- Maximize telemedicine.
One way practices can see more patients is to maximize the use of telemedicine. Many providers successfully adopted telemedicine as a viable solution during the pandemic. Because of the positive results from the perspective of both providers and patients, many providers plan to make telemedicine a regular part of their practice. Because telemedicine is more efficient than in-office visits, practices can utilize this technology to capture more patient visits by training scheduling staff to- identify patients that are good candidates for telemedicine visits based on their condition and the purpose of the visit, and
- educate patients on the benefits of telemedicine, such as saving time and travel and eliminating exposure to other patients.
- Expand office hours.
Practices that were operating at 100% of scheduling capacity before the pandemic will need to look at creative ways to expand their schedule if they want to capture some, or all, of the revenue they have lost. This will mean exploring extended hours and possibly weekend appointments, for a period of time. - Automate wherever possible.
No matter how well a practice is staffed, manual processes are both time-consuming and error prone. Errors are a major reason for late payments and denials. Automation of billing—and further integration with other practice management and EHR functions—solves a lot of these challenges. It also presents a valuable opportunity cost: employees can spend time and energy on more productive, patient- or business-centered activities. Once practice automation is implemented, costs, overall, decrease. - Garbage in, garbage out.
The most important part of the revenue cycle happens in the front office. The adage “garbage in, garbage out” was never more applicable than it is to the importance of capturing accurate information at the start of the billing process. It’s imperative that front-office staff capture patient information correctly. If the demographic data is error-prone, the practice will experience frequent denials. Clean claim rates and denial rates suffer due to problems like incorrect policy numbers, missing pre-authorizations, failure of the diagnosis to support the CPT code, or incorrect modifiers. Billing mistakes are costly; it’s a wise investment to secure experts’ depth of knowledge to achieve a clean claims rate over 95% and a denial rate less than 5%. - Self-pay strategy.
The COVID-19 pandemic has led to more than 30 million layoffs across the U.S., where losing the job usually means losing health insurance, too. Practices need to be aware of the rising number of patients who are classified as “pure self-pay” and decide how to best work with this population to capture this volume. Telemedicine is a solid option, when possible, as it is a more affordable way to provide high-quality care. Certainly, collecting payment at the time of service is prudent for providers, even for patients who are insured; it helps to save on statement costs and eliminate the risk of late or non-payment. Furthermore, practices should consider a payment discount approach for uninsured patients who pay at the time of service. - Plan for the future.
This pandemic has shown providers the importance of having resource reserves—a lesson that may be useful down the road, too. Whether through cash, investments, or lines of credit, availability of funds ultimately determines whether the practice doors will be open or closed when an emergency significantly impacts revenue. When the unforeseeable occurs, the most prudent, practical providers tend to prevail. Practices can also leverage assistance from the Coronavirus Aid, Relief and Economic Security (CARES) Act.
As we all prepare for an uncertain future, a solid plan to efficiently manage revenues, tighten coding processes, and utilize telehealth and automation capabilities will give providers their greatest shot at success.