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Strategies for Managing Revenue Cycle Management

Strategies for managing your revenue cycle during COVID-19 and beyond


5.20.2020 By Availity

COVID-19 has forced most healthcare organizations to restructure the ways they operate. Practices and hospitals not on the frontlines of fighting the pandemic have seen reduced—or non-existent—in-person patient visits, and perhaps an increase in telehealth visits. As we head into summer, many states have started loosening shelter-at-home restrictions, and patient volume is beginning to increase for non-urgent and elective procedures. But it’s possible that many organizations won’t see a return to pre-COVID levels for some time.
Whatever happens over the next few months, revenue cycle staff must stay focused on cash flow. How can your organization optimize operations to reduce claim errors, manage denials, file timely appeals, and maintain patient satisfaction? Here are some strategies to consider:   
  1. Submit transactions electronically
    The pandemic has demonstrated how much we still rely on printers, faxes, and postage meters to process paper-based claims. When staff is at home without access to that equipment, it can delay timely processing. One of the most impactful things you can do to streamline operations and reduce costs is to make sure your organization is leveraging all the ways it can submit electronic transactions.

    Availity RCM users can use the Drop-to-Paper Claims Report/Unmapped Payer Report to see if there are any payers marked as drop to paper that can be set to electronic. You can also ask your account manager to run an ERA gap analysis to identify all remits that are being sent via paper. Check to see if those payers now offer electronic ERA enrollment and take the time to complete the enrollment process. And it may be time to finally upgrade to one of Availity’s paper-to-electronic solutions, such as Workers’ Compensation and Automobile Liability, Drop-to-Paper for Secondary Claims, or All-Payer Attachments for Medical Claims.   

  2. Clean up claim errors 
    Whether your organization has been holding COVID claims to ensure they are as clean as possible before submitting, or you’re seeing reduced volume because of fewer visits, now is a good time to focus on cleaning up all outstanding claim submission errors and getting them out the door. Availity RCM users can check the Edit/Error queue, which allows you to sort and filter claims to determine what to prioritize. You can also use the Edit/Error Management Report to track errors and identify trends. Consider implementing new edits to stay on top of these trends.

  3. Follow up on account receivables 
    How many times have you wished you had a few extra hours in the day to get ahead of your account receivables? With patient volume down, this is your chance to focus staff on critical follow-up activities and get cash flow moving. Start by reviewing your oldest claims and your high-dollar claims. Are there claims waiting for supporting medical documentation? Are you filing appeals wherever possible? Availity RCM users can leverage the Remit Delivery Report to track remits and monitor any delays in payments and the Remit Adjustment Detail Report to better understand denial reasons.   

    As you complete this work, consider what processes can be put in place to prevent denials in the future. Can you address common coding errors with targeted staff training? Are there adjustments to the check-in process that will reduce eligibility issues? Investing the time now to identify the root cause of problems can pay off when the office gets busier.

  4. Review your organization’s financial policies
    The unemployment rate is rising as a result of the economic slowdown, so you should expect to see more patients without health insurance coverage. As you prepare for questions from patients and staff, your organization may want to reevaluate its financial policies as they relate to charity care, bad debt, and patient payments. 

    If you decide to make changes, be sure to communicate the new policies to the entire organization. Too often, financial decisions are made and disseminated among back-office staff, but the information is not effectively rolled out to the individuals answering patient questions at check in. Also, if you have financial scripts integrated into your pre-service workflow, make sure those are updated with the revised talking points.   

  5. Reassign responsibilities with staff strengths in mind 
    Many organizations have had to reduce staff hours or temporarily reassign employees to other roles. In making decisions about how best to deploy resources, consider leveraging overlooked skills. For example, do you have an employee who is a Medicare expert who can focus on working those denials? Or are there experienced patient account representatives who can temporarily handle patient registration and intake? This may also be an opportunity for less experienced employees to shadow seasoned staff members. Cross-training staff in different roles can help your organization build capacity for when operations return to normal. Don’t forget:  Availity RCM has several reports that provide insight into staff productivity.

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