PYA Covid-19 Information Hub
Published March 27, 2020

5 Practical Revenue Cycle Initiatives During COVID-19

The COVID-19 pandemic continues to be a major concern for our frontline medical workers. Healthcare executives are working tirelessly to ensure their staff have the necessary support and equipment to provide proper patient testing and treatment. While plans and communication strategies change almost hourly, it is easy to understand the heightened concerns around managing the revenue cycle and financial operations.

At this uncertain time, with many uncontrollable factors causing lower patient volume, which in turn attributes to lower claims volume, hospitals and providers need strategies for accelerating cash flow. By educating coders and billers, updating new COVID-19 modifiers and billing edits, and streamlining policy and procedural efforts, hospitals can ensure payment on claims related to the Coronavirus are not delayed. And while that is important, it is also key that hospitals and providers focus on what can be controlled, which sometimes means going back to the basics.

PYA suggests business office staff focus on the following “5 Practical Revenue Cycle Initiatives During COVID-19,” to increase cash flow.

1.     High-Risk Account Review and Aged Accounts Receivables (A/R) Analysis

  • Identify A/R that is deemed “high risk.” Some examples include:
    • High-dollar balance accounts: $100K+ for hospital and $10K+ for physician.
    • Acounts $10K+ for hospital and $1K+ for physician, and more than 90 days from discharge.
    • Accounts with no bill date and greater than 30 days post-discharge.
  • Review each account population, and determine common reasons for process, payer, or system breakdowns. Take the appropriate next steps, and elevate accounts, as needed.
  • Perform this analysis to increase cash and reduce A/R in high-risk populations.

2.     Timely Filing and Timely Appeals Review

  • Create a list of each payer’s timely filing and appeal deadlines.
  • Identify unbilled accounts nearing the timely filing deadline, and prioritize them for resolution.
  • Review claims that were denied for timely filing to identify accounts that are nearing appeal deadlines, and take the necessary next steps.
  • Perform this review to increase cash, accelerate submission of unbilled claims, and reduce timely filing denials and write-offs.

3.     Like-Balance Analysis

  • Pull a list of similar balances by payer group, and sample the accounts to determine if the balance is due for follow-up (use batch follow-up if possible).
  • Take the appropriate next steps for collecting like-balances, which are typically low-dollar and represent patient responsibility.
  • Perform this analysis to increase cash (patient responsibility) and to provide more accurate reporting of adjustments, since these accounts could otherwise fall into a low-balance (auto) write-off workflow and not get reviewed.

4.     Self-Pay Linkage Analysis

  • Compare a list of self-pay A/R patients with the list of insured A/R patients to determine if any self-pay patients also have coverage through commercial insurance, Medicaid, or other programs.
  • Perform this simple analysis to increase cash from insured patients, increase cash from self-pay patients, and decrease bad debt write-offs.

5.     Vendor Analysis

  • For business offices with additional capacity: Use this time to review vendor contracts, reconcile accounts currently with vendors, and assess the quality of work from vendor partners.
  • Employ this analysis for more efficient vendor partnerships, in turn increasing cash flow.

If you have any questions regarding these initiatives or require assistance in developing action plans for implementing them, contact one of our PYA executives below at (800) 270-9629.

About the Authors

Interested in Learning More?

Sign Up for Our Insights, Including COVID-19 Bulletins!

Select Your Subscriptions