Finding new revenue opportunities and avoiding claims denials has taken on greater urgency as hospitals and other healthcare organizations face growing reimbursement shortfalls in the wake of the COVID-19 pandemic.
It is why Hayes, makers of the industry’s leading integrated compliance and revenue integrity platform for the nation’s premier healthcare organizations, has launched Revenue Optimizer to equip healthcare organizations with actionable insights that help eliminate barriers to revenue integrity and manage overall financial performance.
A study commissioned by the American Hospital Association (AHA) found that many U.S. hospitals were struggling with ongoing operational losses well before COVID-19, and the median hospital margin overall was a razor-thin 3.5%.
Even with government support from the CARES Act, these margins were projected to drop to -7% in the second half of 2020 without further federal intervention. The study also concluded that, post-pandemic, at least half of the nation’s hospitals would continue operating with margins in the red without any additional support.
“Adding to existing bottom-line struggles, the Centers for Medicare and Medicaid Services identified $29 billion in improper payments in 2019—a trend that will continue as regulatory scrutiny turns to COVID-19 incentive payments.
Further, the addition of nearly 750 new CPT and ICD-10 codes—on top of COVID-19 changes—has created a compliance nightmare that will only exacerbate a devastating financial impact if healthcare organizations can’t stop the hemorrhaging,” said Hayes CTO Ritesh Ramesh, noting that Hayes identified a 20% increase in denials totaling $2.5 billion related to COVID-19 coding and reimbursement challenges alone in the first half of 2020 among MDaudit Enterprise cohorts.