COVID-19 Transformed the Health Care Revenue Cycle
For over a year now, physicians, nurses, and other health care providers have stepped up to an unprecedented challenge. A rapidly escalating public health crisis left providers scrambling to impose new safety protocols, establish makeshift clinics, and deal with staff and supply shortages — all under threat of exposure to COVID-19. Everyone hailed them as heroes. But behind the scenes, other health care workers toiled without public recognition.
Medical billing and coding aren’t glamorous, but they form the backbone of the health care revenue cycle in the United States. The pandemic put tremendous strain on the entire industry. Billers and coders were not exempt. Like many in health care, their jobs, and the revenue cycle itself, were changed by COVID-19 — changes likely to persist as we move beyond the pandemic.
Revenue cycle challenges
Providers and health care facilities saw drastic revenue drops as patients, fearing exposure, stayed away. Common inpatient procedures normally account for 50% of total payments made to hospitals, but they decreased by up to 99% during the pandemic’s early stages. Patients let bills slide as they struggled with layoffs and work closures. For medical billers and coders, work and claim volumes were erratic and unpredictable.
Coding and billing challenges
Providers and health care facilities were the public face of our collective crisis, but they weren’t the only workers saddled with challenges during the pandemic. Social distancing and other pandemic safety protocols disrupted workplaces, and the shift to remote work led managers to adopt new work practices. In this chaotic work environment — and on top of shifting code sets to account for the virus — coders and medical billing staff adopted the most significant change to the Medicare Physician Fee Schedule in decades. Confusion over new codes brought an increase in claim denials.
After the pandemic
COVID-19 wreaked havoc on the economy — especially on the health care industry. We are just now beginning what promises to be a long recovery, but some challenges and changes improved care, and they are likely here to stay. These include:
Increased use of telehealth and virtual visit services
Digital transformation with increased use of automation, virtual care, and electronic health records (EHR).
More emphasis on training to address problems with documentation errors and claim denials.
The past year has been one for the record books, and we hope never to face another crisis of this kind. But we’ve also learned that some challenges make us stronger and accelerate positive change.
