The stress of front-line providers has justifiably gotten large amounts of attention. But at the same time, hospitals and health systems are fighting a silent battle — one that will impact the revenue cycle for months, and possibly years into the future.
The hospital revenue cycle has been thrown into new challenges because of increased patient loads, a decrease in profitable service lines, as well as strains on revenue cycle and clinical staff. While the focus now is immediate, here are three ways to plan for the future by considering outsourcing medical coding and medical billing to avoid an even more serious financial impact from the COVID-19 pandemic.
1. Outsourcing to Answer the Non-Essential Service Problem
On March 18, CMS announced a delay on all elective surgeries as well as non-essential medical, surgical, and dental procedures during the COVID-19 outbreak [1]. This was in part to encourage patients to stay at home but also to preserve personal protective equipment and free up the healthcare workforce.
For hospitals, this is no small shift. Elective surgeries alone, for example, are a major source of revenue. They can bring in $700 more per admission than ED services, meaning hospitals are now left with unprecedented revenue challenges [2].
Why Outsource?
The American Hospital Association has stepped in and requested an additional $25,000 per bed in the most heavily impacted areas, but in the meantime, hospitals will need to make smart decisions around the use of existing resources [3]. For many, this will mean considering outsourcing options as critical staff are reallocated to areas of more immediate need.
2. Outsourcing Billing and Coding During COVID-19
Medical billing and medical coding in the wake of COVID-19 has gotten more complex. Here are some of the highlights as reported by Becker’s Hospital Review [4].
- CMS has developed and released the HCPCS code U0001 to allow labs and providers to bill for the CDC’s RT-PCR diagnostic test panel. (Healthcare organizations should use code U0002 to bill for in-house developed COVID-19 tests.)
- When Medicare beneficiaries with the virus no longer require acute IP care but are still quarantined, Medicare will pay the DRG rate plus any outliers until the patient is discharged.
- Patients will not have to pay an additional deductible for quarantine in a hospital if they would have been discharged under other circumstances.
- Hospitals that offer both private and semi-private rooms are not eligible to charge patients a private room differential where isolation is deemed medically necessary.
- CMS announced on March 10 that it is expediting the creation of CPT codes for reporting COVID-19 tests.
It’s not difficult to see how this will create new challenges for billers and coders today, but also reverberate downstream in the revenue cycle in the form of denials, appeals, and underpayments. This is a time when proper coding and billing are more important than ever, but at the same time, staff is overworked, stressed, working from home, and often focused on higher-priority tasks.
Why Outsource?
Outsourcing these functions, billing and coding in particular, relieves leaders of difficult decisions around transitioning workers to work-from-home assignments and then back into on-site work, and externalizes the risk of swings in labor demands to a partner who is experienced in handling them.
3. Finding a Clinical Documentation Partner During COVID-19
Clinical documentation has a direct impact on billing and coding and in turn, cash flows.
Take the application of Section 1135, which allows for the temporary waiver of certain Medicare, Medicaid, and CHIP requirements and helps ensure that providers who are operating in good faith are properly reimbursed and exempted from sanctions during a crisis. Healthcare lawyer, Delphine O’Rourke advises healthcare providers on the use of 1135 waivers.
“It is very important for providers to get in line. HHS is going to receive a lot of waivers. Internal staffing hasn’t been increased. The sooner providers can get them in, the better they have of being viewed at the front end.” She continued, “Why they’re billing this way is also going to be important. There’s going to be a backlog or vulnerability at the end that there was no ‘proof’ that that was why these actions were taken. There have been no waivers of documentation, so it’s critical, critical, critical.” [5]
Why Outsource?
The issue here is that physician availability is already pushed to the brink, and doctors are busy with their primary job of caring for patients. This re-prioritization jeopardizes reimbursement across the board. Tired doctors are already citing relief from “the burnout-inciting frustrations of billing and documentation”, but what stands as a relief for physicians who might have a distaste for administrative work also sits as a prediction of problems coming down the road for revenue cycle leaders [6]. One solution is to outsource medical billing and medical coding to a partner that understands clinical documentation improvement and who can absorb and even correct in areas where you are weak.
Outsource Medical Coding and Billing to Navigate COVID
The good news is that providers do have options.
One is to charge ahead and hope everything works out — an approach that seldom turns out well in the hospital revenue cycle. Another is to brave the mountainous task of shaping current resources to fit the challenge at hand, if extra resources are even available. The third is to bring on an outsourcing partner who, even in the face of the current and very likely growing reimbursement crisis, can stay focused and agile enough to keep their organization on top of the fast-changing requirements and emerging opportunities that this pandemic is presenting.
If you’re curious about what that last option would look like for your organization, we would love to talk.
References
[1] U.S. Centers for Medicare & Medicaid Services, “CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response,” 18 May 2020. Available: https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental.
[2] A. Stewart, “Hospitals forfeit major revenue stream by delaying elective surgeries — 5 things to know,” Becker’s ASC Review, 20 March 2020. Available: https://www.beckersasc.com/asc-coding-billing-and-collections/hospitals-forfeit-major-revenue-stream-by-delaying-elective-surgeries-5-things-to-know.html.
[3] J. LaPointe, “AHA Asks for an Immediate $25K Per Hospital Bed to Combat COVID-19,” RevCycleIntelligence, 2 April 2020. Available: https://revcycleintelligence.com/news/aha-asks-for-an-immediate-25k-per-hospital-bed-to-combat-covid-19.
[4] A. Ellison, “Billing and coding for coronavirus: 7 things to know,” Becker’s Healthcare, 11 March 2020. Available: https://www.beckershospitalreview.com/finance/billing-and-coding-for-coronavirus-7-things-to-know.html.
[5] J. LaPointe, “Documentation to Ease Medical Billing Issues Due to COVID-19,” RevCycleIntelligence, 24 March 2020. Available: https://revcycleintelligence.com/news/documentation-to-ease-medical-billing-issues-due-to-covid-19.
[6] D. Khullar, ““Adrenaline, Duty, and Fear”: Inside a New York Hospital Taking on the Coronavirus,” The New Yorker, 3 April 2020. Available: https://www.newyorker.com/science/medical-dispatch/new-yorks-hospitals-take-on-the-coronavirus.
