Revenue cycle faces unprecedented challenges, but old truths point the way to new solutions

Jesse FordCOVID-19, Revenue Management

We’ve done it before.

While we cope with financial and mental stress in an uncertain environment, revenue cycle leaders can draw upon the well of experience they have in adjusting to previous change in our dynamic healthcare industry. We’ve withstood several downturns in the economy. We’ve overcome vast changes in the payer market, reimbursement systems, coding systems and new technology. And we have incorporated groundbreaking new ways to treat patients. We know how to cope with change, and as we reflect on our current state, we should keep focused on the verities that existed before COVID, because they are still here, and in some ways are more profound today.

Patient satisfaction
Our patients may be facing new circumstances, and we need to advocate for them to ensure their experience with revenue cycle is not a source of pain. Generally, I’ve always believed in treating patients with kid gloves, particularly the higher-balance accounts. That truth remains. Anticipate patient pain, help patients find insurance coverage, simplify the process for applying for financial assistance, offer flexible payment arrangements, and make sure that patient balances are accurate and we are not asking patients to solve insurance problems that we are better prepared to handle.

This is a great time to design a model that better marries service with effective collection practices. Our industry has focused on price transparency, as it should, but our model should also aim to simplify how patients navigate revenue complexity, by providing communication and payment options that patients prefer and understand. And, our work today can look for innovative models that boost collections in a patient-friendly way, such as leveraging social psychology, segmentation based upon advance analytics, and/or through a focus on working with patients on the front end.

Employee engagement
Revenue cycle experts are certainly facing new circumstances, as health systems move staff home, ask staff to take on different responsibilities, and sometimes furlough large pools of experienced caregivers. A truth that existed before today’s pandemic still remains; as revenue cycle leaders, we need to ensure our staff are engaged in their work. Engagement is a key to quality, productivity and satisfaction.

Salud helped staff transition to home by establishing virtual “coffee breaks” so that staff take some time to connect. We were lucky to already have a home-based model, and our experienced “at-home” staff shared how they created the best at-home work experience.

From Salud’s inception, we have aimed to design our models to put the right accounts in front of our staff at the right times. We refer to this as meaningful work. Through analytics and robotic process automation, we have continuously reduced repetitive “drone” work, and engaged staff with problems to solve.

Our truth is also founded in treating employees like adults. We give our staff objectives, exceptional training and technology-enabled resources to accomplish goals – and then set them free to get the job done.

Improving cash position
The reality is, nobody was perfect at collecting money before COVID, and we are certainly not perfect today. Reduced volumes caused by the COVID crisis free up some staff time to plug holes. One Salud client reflected that it finally was able to get through special projects such as account cleanups, building edits and working backlogged accounts. It is a great time to catch up, but also to design a model that identifies and addresses holes in the revenue cycle. Some systems are rededicating themselves to denial management, which leads to innovative process improvements throughout the revenue cycle. Others are instituting better ways to identify what they haven’t identified themselves, by auditing zero balance accounts to find gaps in business office processes (e.g., billing mistakes, inappropriate write-offs) and payer underpayments.

Growing with the digital age
Another truth that predates COVID and will endure after it is gone is the need to survive in a digital age. Claims denials and chronic underpayment are age-old problems in revenue cycle, but we can’t just throw endless staff time at these issues. Instead, process automation, analytics and, someday soon, artificial intelligence are means to achieving revenue cycle optimization, which combined with expert staff takes the guesswork out of reimbursement.

These are big challenges, made all the more difficult by COVID. And yet, we’ve done big things before and can do them again.