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COVID-19 Downtime Spawns Home and RCM Improvements

Updated: Jul 25


The average medical practice will get the biggest bang for the buck by using staff downtime to make improvements in their Revenue Cycle Management (RCM)


Those in the medical community NOT dealing directly with COVID-19 patients are likely experiencing some downtime. We may or may not want to take on home improvement projects with our downtime (mine often end in disaster), but it would be a mistake to let the opportunity to make improvements to our RCM process pass by. The average medical practice will get the biggest bang for the buck by using staff downtime to make improvements in their Revenue Cycle Management (RCM). There are 3 key areas of review:


1) Pre-visit Encounter with the Patient


The pre-visit patient encounter is the opposite of Surprise Medical Billing


Think of the pre-visit patient encounter as the opposite of Surprise Medical Billing. The goal is to preemptively obtain all that is necessary for the smooth “surpriseless” patient billing. The physician’s office and/or even the billing company might have staff with excess capacity to perform tasks they may not have performed “BC” (before COVID-19).


Tasks include:


· Patient insurance verification 2 weeks out (misinformation slow claims)

· Identification of Self-Pay patients (unemployment can = no insurance)

· Obtain prepayment from Self-Pay patients (offer discount w/ credit card payment)

· Patient Counseling (patients need help navigating a payment system foreign to them)

· “Just in Time” insurance verification (recheck 1-2 days before services (status is fluid))


NOTE: I understand the above is completely foreign to my friends in anesthesia, but it's a new world out there and some of the above can be implemented with the assistance of the facility (i.e., get a list of schedule cases and patient demographics).


2) Coding and Claim Filing


Incorrectly paid claims due to an inaccurate Fee Matrix (including overpayments) slow the AR Team down with needless reviews


· Payers occasionally make changes to their edits of their coding/billing protocol. Make sure your claims are “clean” via updating policy as needed.

· Assure the Fee Matrix is updated. Fee schedules often change annually as per the contract. Incorrectly paid claims due to an inaccurate Fee Matrix (including overpayments) slow the AR Team down with needless reviews.


3) Claims Follow-up


$3 x 1,000 underpaid claims a month is a giveaway to the insurance companies of $3,000 a month


· Most billing software allows an “acceptable” underpayment from payers (i.e., $5 or less underpayment doesn’t alert the AR Team of a discrepancy). With downtime due to lack of volume, consider having the AR Team follow-up on smaller underpayments ($3 x 1,000 underpaid claims a month is a giveaway to the insurance companies of $3,000 a month).

· ID systemic payment problems (i.e., same problem) by payer and type of service and follow-up with problem payers. Share this information interdepartmentally (siloed AR Team members with other clients are likely experiencing the same issues).

The RCM Optimization Cycle


The renovation of an RCM process is a continuous cycle of improvement that includes frequent cooperation and communication between providers and their billing office/company (see cycle slide below). A “Top Shelve” billing company will have this process built into their corporate culture, but it’d be a good time to “check fences” and assure everyone is accommodating the new challenges in RCM fostered by the COVID-19 crisis.

More with Less


In these difficult times, with less patient volume and a changing payer landscape, we are looking to make more with less (more money per case to offset less cases). That’s possible when we focus our downtime on improving our RCM processes. Some of the changes made will remain beyond the COVID-19 crisis, because they are timeless. Some changes will be left behind after the crisis because they are not efficient with everyone fully engaged. The shrewd medical practice and billing company will reassess all things after the crisis passes.


Stay safe and Godspeed. Grant

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