Revenue cycle trends to monitor during COVID pandemic

Revenue cycle trends to monitor during COVID pandemic

The following is column from Stark CEO Mick Raich:

The health system shut downs that took place in April and May (and in some instances stretched further) are still having downstream effects on revenue cycle operations for many of our clients. Unfortunately, we are seeing multiple issues because of this.

One of the services we provide is assisting our clients with building a request for proposal (RFP) process for choosing a new biller. This process can either go very smoothly and lead to a smooth transition, or it can be a disaster if the new biller fails the start-up process. Using Stark to help with this process helps make this change less dramatic. We are seeing a large number of clients changing billing services due to poor operations and results that are directly tied to the COVID issue. 

During the shutdown many billers laid off employees and have yet to rehire them. We know of some billers who are still down 100 employees from pre-pandemic levels. Several well-known, nationally recognized billers are having major issues with missing accessions, lost addendums and rising account receivables. Overall, the follow-up on the day-to-day billing issues are not being solved and our clients are saying enough is enough.

Another major issue concerns new COVID labs who know how to do COVID testing without having a real idea how to do the billing. This means these labs are spending millions of dollars to ramp up for COVID testing, but have untried and untested revenue cycle processes that are leading to millions of dollars in lost revenues. Several new labs have bought billing systems but do not have the knowledge to do billing. Others have signed contracts with unexperienced and subpar billers. In one instance, a new client noted they billed 23,000 COVID-19 tests during a one-week period several months ago, however, they have been paid on only 12 of these claims. 

The final issue we are seeing is an increase in reluctance for billing companies to turn our audit results  in a timely manner. This means our audits, which hold these billers accountable, are delayed. This ultimately leads to lost revenue as billing issues are not being resolved.

Effectively managing the revenue cycle process during these unprecedented times is difficult given that there are so many new and existing variables to consider in order to correctly to get paid. The front-end process must be clean, the demographics must be correct, the insurance requirements must be met, etc. Then, the claim has to be paid correctly, appealed if denied, and researched if paid incorrectly.

It is no wonder so many claims go unpaid or underpaid. Tie this into the fact many revenue cycle billing firms are struggling, and you have the perfect storm of revenue cycle failures.