COVID-19 Impact on Healthcare Revenue Cycle
Revcycleintellegence.com (Jaqueline LaPointe)
Covid-19 has created unique healthcare revenue cycle challenges around:
Billing and Coding
Patient Financial Responsibility
Resource Allocation
In March 2020, nations the world over encouraged their entire populations to stay indoors or at home to avoid the coronavirus, Covid-19. Healthcare providers went into overdrive in response to the massive outbreak of the novel coronavirus. This had an immediate impact on the healthcare revenue cycle and provider finances.
In early March, stocks plummeted as a result of the global Covid-19 outbreak and healthcare providers were not immune to the trend. Stock prices for major for-profit hospital systems fell significantly.
Non-profit hospital systems, academic medical centers and physician practices also face financial challenges stemming from Covid-19.
According to a report published in the Lancet, about one third of the confirmed cases in Wuhan, China, where the coronavirus originated, required ICU services.
A larger study later confirmed the findings that showed a case-fatality rate of 2.3 percent. The mortality rate was significantly higher among the critically ill or higher risk conditions.
These early findings gave rise to the concerns of medical equipment and critical medication potential shortages such as ventilators and antibiotics. In addition, many hospitals feared the shortage of PPE, personal protective equipment such as masks and gloves.
Healthcare providers are rapidly implementing emergency preparedness plans, seeking places to put overflow patients, acquiring diagnostic tests, administering therapeutic medicine, identifying and protecting staff, and more.
To help providers handle the new challenges, the government and payers are helping to alleviate the revenue cycle obstacles presented by Covid-19.
BILLING and CODING:
Keeping the billing office running during an outbreak is key to keeping hospitals and practices open for infected individuals requiring care. This can be a challenge, especially for smaller organizations with limited cash on hand to respond to Covid-19 demands.
CMS has been at the forefront of helping providers handle the medical billing and coding aspect of Covid-19 testing and treatment. The agency released two Healthcare Common Procedure Coding System (HCPCS) codes that laboratories can use to bill for certain Covid-19 diagnostic tests, including those developed in-house according to FDA guidelines.
The American Medical Association (AMA) is fast-tracking the development of a unique Current Procedural Terminology (CPT) code for reporting novel coronavirus testing. CMS also released guidelines on billing and reimbursement. The agency reminded providers that Medicare will pay for evaluation and management (E/M) and other services furnished in a beneficiary’s home by a physician or non-physician practitioner. Medicare will reimburse providers for many non-face-to-face services used to asses and manage a beneficiary’s condition.
For Hospitals, Medicare will pay the diagnostic-related group (DRG) rate and any cost outliers for the entire stay if the beneficiary is a hospital inpatient for medically necessary care. This includes quarantine stays.
Hospitals almost at capacity during an emergency may also be able to add a remote location that provides inpatient services even in the absence of an 1135 waiver, CMS stated.
The Trump administration is also implementing a natural disaster program to pay hospitals and other providers for treating uninsured patients infected with Covid-19. The program typically pays about 110 percent of Medicare rates.
PATIENT FINANCIAL RESPONSIBILITY:
Several reports have surfaced of patience being left with thousands of dollars in medical bills after seeking care for coronavirus symptoms.
Healthcare providers are struggling to develop collection strategies in the era of high-deductible health plans and other cost-sharing arrangements.
Payers are acknowledging the difficulties arising from patient financial responsibility and many are making it easier for patients to seek care and for providers to streamline the financial encounter.
America’s Health Insurance Plans is implementing solutions to lowering out-of-pocket costs for people seeking testing for and treatment of Covid-19.
AHIP members vowed to ease network, referral, and prior authorizations requirements and/or waive patient cost-sharing for physician-ordered Covid-19 testing. They will also work with providers to ensure that effective treatment is available for those who are infected.
ALLOCATING RESOURCES:
Covid-19 has put a lot of demand on an overburdened healthcare system, overwhelming the capacity of hospitals, emergency departments, and outpatient centers. This resulted in critical shortages of staff, space and supplies. All of which can have a negative impact on patient outcomes according to the National Academy of Medicine (NAM).
NAM recommends that healthcare providers develop “tiered, proactive strategies using the best available clinical information and building on their existing surge capacity plans to optimize resource use.
Specifically:
Protect their workforce by offering staff childcare, alternate housing, balanced shifts and additional support and training.
Preserve personal protection equipment by reserving these supplies for those performing high-risk interventions, using powered air-purifying respirators in high-risk environments, continuous use of supplies in a cohorted patient environment, and more…
Optimizing outpatient services by extending hours, adjusting staffing, closing or reducing specialty clinic hours and changing documentation.
“It is important that hospitals take steps to develop a process for decision making, anticipate the need for resources, and involve clinical staff in developing strategies to address the broad range of impact,” the organization concluded.
Covid-19 Guidelines can be found at www.cdc.gov