By Vasilios Nassiopoulos, vice president of platform strategy and innovation, Hayes.
2020 will undoubtably be a year that the healthcare industry will want to forget. The COVID-19 pandemic not only introduced unprecedented care delivery challenges—at least in modern times—but has also left devastating financial consequences in its wake for today’s providers.
Razor-thin pre-pandemic margins of just 3.5% are now met with the reality that 97% of health systems will lose an average of $2,500 per coronavirus case despite incentives. Further exacerbating the situation is an expected increase in denials as healthcare organizations learn how to interpret new guidance around coding and billing for COVID-19 related care.
While many in the C-suite may be tempted to put their head in the sand and wait for the industry to round the corner into 2021, there is an opportunity to change current dynamics in the last lap of 2020. Amid many lessons learned from the pandemic, healthcare organizations must consider the role of sound revenue integrity practices for future preparedness and sustainability.
Progressive revenue integrity models are designed to integrate systems and processes for the purpose of eliminating revenue cycle complexities arising from issues like COVID-19 that can fast become liabilities for providers. Within these models, healthcare organizations are increasingly finding that strong partnerships between revenue integrity, revenue cycle and billing compliance teams are essential. While these functions have, more frequently than not, operated in siloes, embracing shared monitoring and auditing processes can streamline budgets and improve revenue recoupment and generate long lasting collaboration and communication.
To get ahead of the evolving revenue storm, hospitals and health systems can take four steps to get their billing and compliance house in order:
Implementation of electronic health records is considered a national priority in this era of healthcare reform. However if EHRs are not implemented correctly they can be painful.
EHRs that are not implemented effectively can affect productivity and revenue. The extra documentation requirements and intricate workflows create distance between physicians and their patients. Physicians have reported that they spend too much time on EHRs and that they don’t get enough time to interact with their patients. But physicians often communicate that spending time on EHRs is crucial to creating a trusted set of structured data that can guide their business. Every click that providers make creates important data points that can be used to inform the efficient delivery of their practice.
Every EHR saves a large amount of data inside it regarding patient health, effectiveness of treatments, system efficiency and provider tendencies. Despite the extra time and effort that is dedicated to electronic documentation, many practices and physicians do not make full use of this precious data set that they have produced.
If a practice can get its EHR adoption right they can make a number of positive results, some of which are mentioned below:
By overcoming the difficulties providers can see more patients and will be able to generate more billed revenue using its existing staff. Furthermore, if a provider is using its EHR efficiently then the improved documentation produces billing at higher rates, combined with increased patient flow. This represents significant potential revenue.
Quick Cash Flow
Many of the practices work on revenue cycle management, but few make it flawless. With increased charge accuracy and reduced time for denials, there will be an increase in the yield with timely reimbursements by the payers.