Optimizing RCM after COVID-19
The COVID-19 pandemic has affected virtually every aspect of our lives, and its effects are expected to linger long after the immediate threat subsides. This is especially true for the U.S. healthcare system — which continues to suffer critical shortages and revenue loss. Bouncing back will require time, strategy, and rethinking revenue cycle management (RCM) operations.
The COVID-19 effect
As the pandemic drags on, healthcare providers and hospitals remain overburdened by their regular workload and new cases of COVID-19. Staff shortages — caused by illness, burnout, and refusal to comply with vaccine mandates — further complicate matters. With less capacity for outpatient and non-emergency care, revenue losses are straining healthcare organizations to their breaking points.
RCM efforts have suffered as well. Layoffs, business closures, and illness have created financial hardship for patients, many of whom are now struggling to keep up with medical payments. Some providers have paused collection activity, and an influx of new Medicaid and Medicare patients have further decreased revenues. The Centers for Medicare and Medicaid Services (CMS) price transparency rule — which took effect at the beginning of 2021 — requires providers to share their pricing information, so patients can make informed choices, but ensuring compliance also adds to the RCM workload.
RCM changes
Patients and frontline workers bear the brunt of the pandemic’s impact, but it’s hit behind-the-scenes workers as well. COVID-19 created upheaval in RCM operations, and while some are likely short-term — such as uneven, unpredictable claim volumes — others are bound to stick around.
Remote RCM, for instance, had its challenges in the beginning, but almost two years into the pandemic, workers have largely adjusted to new ways of operating and resolved the problems initially raised by security concerns, isolation, schedule management, and the new codes, regulations, and processes required by CMS rules. Meanwhile, patients have grown accustomed to more convenient digital options — such as telehealth consultations, online patient portals, and billing options — and they expect the convenience to continue.
Optimizing RCM
Hospital revenues took a hit during the pandemic, so it’s vital to optimize RCM immediately to mitigate further financial fallout. Enhancing digital service options is priority one. A recent Gartner report outlines more basic steps for post-pandemic RCM optimization:
Strategize for digital transformation. Evaluate your organization for the necessary digital infrastructure and technical expertise. Consider partnering with a third-party vendor experienced in digital RCM processes and procedures.
Increase electronic claims submission. Increase electronic submissions to at least 95% to ensure accuracy and completion and significantly decrease processing time.
Reduce accounts receivable time. Map all denial codes in the digital RCM system and transfer balances due to the next responsible party — either patient or payer.
For additional assistance optimizing RCM in the wake of COVID-19, contact the healthcare billing experts at HRG.
