How to Overcome Erratic Claim Volume Due to COVID-19

How to Overcome Erratic Claim Volume Due to COVID-19

Free Guide: 4 Tips for Mitigating Revenue Cycle Disruptions

By April 2020, outpatient visits fell nearly 60% from pre-pandemic levels. Some specialties such as dermatology and adult primary care are rebounding, but many others are still suffering from decreased patient visits and patient volume fluctuations.

Although the end is (hopefully) in sight for the pandemic, it’s going to be a tough Spring for healthcare providers; especially those that do not know how to overcome erratic claim volume due to COVID.  Many organizations are finding that fluctuating patient volume due to lockdowns and canceled elective surgeries is significantly impacting cash flow. According to a recent survey, 50.5% of health system chief financial officers and revenue cycle leaders said that work and claim volumes have been unpredictable during the pandemic. Primary care practices are being hit particularly hard by patient volume fluctuations– one estimate predicts that by the end of 2020, primary care lost $67,774 in gross revenue per full-time physician.

There is no doubt that surges and falls in patient volume affect revenue; however, another less obvious consequence is that it can obscure inefficiencies in the claims cycle. Claim delays and disruptions caused by workforce issues and unfamiliar denials can profoundly affect cash flow – and mimic the effects of volume fluctuations.

How to Overcome Erratic Claim Volume Due to COVID

4 Steps you can take to protect your revenue cycle from the consequences of fluctuating claim volumes during COVID

1.) Stay on top of the latest coding requirements.

Confusion about COVID claims can become labor bottlenecks that delay much-needed revenue. One survey found that 37% of respondents reported increased workloads due to coding and other requirements related to COVID. (Find official AMA guidance about COVID coding here.)

2.) Predict uneven cash flow by tracking visit volumes.

Knowing how volume varies from week to week can help uncover inefficiencies in your revenue cycle. If you know your average reimbursement timeframe, you can predict when you may see dips in revenue. If a dip happens outside of an expected reimbursement window, it could be due to operational difficulties and not volume. Never assume that drops in revenue are due solely to patient volumes. If or when you see a reduction in payments, it is critical to understand precisely why the decrease happened – an immediate investigation is needed to find the source of disruption.

3.) Confirm you are taking full advantage of telehealth options.

Telehealth has proven itself as a viable in-person visit alternative for many types of services during the pandemic. There are over 200 available CPTs for telehealth – ranging from new patient E/M visits to physical therapy. (Find permanent and temporary codes here.) Telephone visits for new and established patients and remote physiologic monitoring due to COVID quarantine can be an option for care as well. The American Medical Association has published useful resources for coding visits during COVID here.

4.) Mitigate staffing and productivity issues with outsourcing.

The pandemic has wreaked havoc on revenue cycle operations for many providers. According to a recent HFMA study, COVID workload fluctuations have caused overstaffing issues for almost 36% of respondents, and productivity decreases affected approximately 33% of executives surveyed. Outsourcing part or all revenue cycle management can streamline workflows so staff can worry less about billing and concentrate more on patient care.

Wrapping up How to How to Overcome Erratic Claim Volume Due to COVID

Ultimately, the solution to overcoming erratic claim volume due to COVID is through the use of data and technology.  Billing staff must have an understanding of COVID-specific coding requirements to avoid unnecessary A/R.  And, with the right technology, healthcare organizations can predict cash-flow based on encounter volumes and successfully capture Telehealth revenue.

If you’re a healthcare organization that is either stretched too thin to address these issues or not sure where to start, we have the solution.  Check out our medical billing services then request a time to speak.