The staggering rise of COVID 19 cases has upended the healthcare system in the US to such an extent that normal healthcare services have been brought to a complete halt. Healthcare providers are now required to meet the needs of COVID patients with greater urgency, and at the cost of other treatments.
This has complicated front end and back end operations to no ends. While on the front end, providers have to deal with a highly contagious disease, with a completely new set of conditions, on the backend they have to contend with regulations that are changing by the day. As a result, the delicate balance between the front end and back end operations of a healthcare system has been brought to a tipping point.
Revenue cycle operations are facing the strain for a number of reasons. Firstly, the need to document patients with conditions that have not been documented before, has led to lot of confusion and procedural anarchy. Secondly, billers and coders need to stay abreast of changing coding requirements and payer conditions at a speed much faster than the normal learning curve. Thirdly, billing for COVID 19 patients have to be different from normal billing as the treatment is related to a pandemic with many associated restrictions imposed by regulatory bodies. Lastly, a severe shortage of skilled resources in fields like insurance verification, coding etc. has made it impossible to handle a pandemic of this magnitude with the efficiency it demands.
It’s evident, COVID 19 has exposed the RCM process to challenges that are both unprecedented and seemingly insurmountable in nature. Only a well-defined contingency plan can help providers, take on the challenges in a systematic and dependable manner. To start with, providers need to ensure the following:
Use Disaster Registration Workflow to Setup COVID 19 Treatment Process
Receive the influx of patients for COVID-19 treatment or testing through Emergency Department (ED). In doing so, providers will be using the ED Disaster workflow (as the pandemic has been declared as a national disaster), and thereby find it easy to track and report on these patients during the course of the treatment. This would make entry level segregation of COVID 19 patients possible; help institute a dedicated treatment workflow and simplify the overall RCM process.
Bill COVID 19 Patients in a Special Way
This entails availing the existing Specialty Billing indicator in the providers billing system or creating one such indicator to bill COVID 19 patients exclusively. The big advantage with this is that it will help them identify COVID patients and bill correctly as per latest regulatory requirements. With this in place, it would become easy to review a COVID bill prior to submission.
As new regulations now bar surprise billings for corona patients, reviewing bills can help providers from flouting this requirement inadvertently. Sometimes, a corona patient bill can get inflated due to comorbidities. Billing COVID 19 patients separately ensures that the billing is correct and doesn’t fall under the bracket of surprise billing.
Ensure No Charges for Waived Copays
Insurance companies are waiving copays for COVID-19 testing and treatment. What this means for providers is that they should not request copay payments from patients availing COVID 19 treatments. This calls for an update of the providers Benefits Engine to ensure the copay amount for COVID-19 testing visits doesn’t pop up. It may also need a complete process redesign to write off these charges or introduce a new visit type to signal the absence of a copay.
Bank on Technologies for Documenting
The need to document COVID 19 conditions in a precise, complete and accurate manner is of paramount importance, given that this information will be sought by researchers to treat future coronavirus outbreaks. However, shortage of trained resources in the face of such huge requirements is making it impossible to document present conditions accurately. Yet another challenge is to handle the tsunami of data generated by the disease and its aftermath.
The best way to ease documentation woes is to ensure physicians and support staff bank on electronic recordings on a large scale. Instead of the normal practice of jotting notes, physicians should use their smartphones to audio record notes during patient visits. These audio records can be directly sent to a remote transcriptionist who would type them into unstructured clinical documents.
After transcribing them, providers can leverage advanced technologies such as Machine Learning, Artificial Intelligence, and Natural Learning Process to convert the document into interoperable data. This way, the avalanche of data can be handled in a more streamlined manner and structured almost instantaneously for future use.
Tailor a Long-Term Plan to Combat the Looming Resource Crunch
As COVID 19 worsens, healthcare providers will have to deal with increased staff shortage, as a majority of the staff, in all likelihood, will be facing health emergency in their communities. And if there is shortage in patient access staff i.e. staff at the frontend of patient care, revenue cycle will take a hit at its very foundation. Most small-time providers are trying to solve this by cross-training medical billing and coding staff to register patients. While this may seem to be the right approach in a crisis-ridden situation, it is likely to tax an already overburdened billing and coding staff and limit their ability to bill and code more efficiently.
Self-Service Tools is the Need of the Hour
This is the right time to upgrade to self-service tools. With such a tool in place you can prevent non-emergency patients from coming to the facility and reduce the need to depend on front-end staff to handle patients.
For instance, patients can use a self-service app in their smart phones to sign and submit all consent forms and disclosures, prior to their visit to the facility. This will reduce their waiting times in the facility and also make the process almost touch free. Likewise, enabling video access to patients for availing telehealth options can greatly reduce the burden on staff. Besides delivering instant service, these tools will also help in improving patient satisfaction which is much needed in a crisis like this.
Enabling Remote Working for Billers and Coders
As COVID 19 spreads rapidly across communities, many billers and coders are suddenly finding themselves working from home for the first time. While HIPAA has waived certain sanctions, to ensure more flexibility in the times of the current crisis, those concerning HIPAA privacy and security requirements remain as they were before.
Allowing vulnerable staff to work from home with all security measures to safeguard patient health information can be a good way to overcome the present resource crunch. Some best practices suggested by AAPC include encrypted and password protected home wireless router, restricted access to PHI, limited email transmission of PHI etc.
Outsourcing Medical Billing and Coding to Experienced Partners
Outsourced service providers have been directly handling the issues associated with self-pay cash flow, regulatory conformity and claims denial since the inception of outsourcing as a service for medical back office support. Their exposure to the US healthcare system is profound enough to help you immensely during this crisis. Therefore, this is the time for you to build on the capacity to handle a spike by outsourcing the task to countries less affected by the pandemic. India and Philippines are two such countries whose potential to match up to the surging demands is huge.
OutsourceRCM, has taken all necessary steps to ensure continued back office support for RCM processes. We have moved all our staff to remote work locations and have placed all IT controls to ensure complete HIPAA compliance with respect to data integrity, security and backup. Our team leaders are guiding our medical billers and coders through the constant changes happening in the coding and payer world, thereby ensuring our clients are fully compliant with newly introduced government policies.
