Why the revenue cycle is vital to exceeding patient expectations and driving financial performance July 2, 2021 Joe Polaris, MBA As physician practices look for ways to build volume and engagement, it’s critical to thoughtfully consider it all from the point of view of patients and consumers. With the COVID-19 vaccine becoming more widely adopted, the US is slowly starting to emerge from the pandemic. While some things, like in-person gatherings, are starting to go back to pre-pandemic normal, there is still a long way to go when it comes to financial recovery. This may seem especially daunting for physician practices, with gross revenue losses estimated at $67,774 per physician in 2020 . Call Today: 614.706.5206          

With the COVID-19 vaccine becoming more widely adopted, the US is slowly starting to emerge from the pandemic. While some things, like in-person gatherings, are starting to go back to pre-pandemic normal, there is still a long way to go when it comes to financial recovery. This may seem especially daunting for physician practices, with gross revenue losses estimated at $67,774 per physician in 2020 .

New legislation, as well as changes in patient expectations, present a host of challenges and opportunities for getting paid for service this year. In a recent article in Physician’s Practice, we discussed the challenges surrounding getting paid for telehealth this year and beyond . This is an essential issue for independent practices, but it’s not the only one. New legislation, as well as changes in patient expectations, present a host of challenges and opportunities for getting paid for service this year. E/M Office and Outpatient Guidelines Changes For the first time in more than two decades, the AMA has revised the guidelines for office and outpatient visit evaluation and management (E/M) codes. It’s been a long time coming—effective this year, CMS has aligned E/M coding with the changes adopted by the AMA. For many providers, this means an increase in their revenue because they will finally be compensated for time spent in activities related to patient care that were previously...

A new code for COVID-19 discharges offers a 20% bump in the assigned MS-DRG payment from CMS. Clinicians should know that a positive test result is not required to establish a COVID-19 diagnosis for coding purposes. If a patient admitted with a respiratory diagnosis then tests positive for COVID-19, coders can link the result to the respiratory illness. With new legislation such as the Coronavirus Aid, Relief and Economic Security (CARES) Act supplying grants to help stabilize hospitals and health systems, documentation and coding become increasingly vital for providers to capture the available funding. An unprecedented off-cycle adoption of code U07.1, COVID-19 , effective with discharges on and after April 1, 2020, was announced by the Centers for Disease Control and Prevention in mid-March.  As provided in the ICD-10-CM Official Guidelines for Coding and Reporting, the coding guidance for COVID-19 has unique features that all coding professionals and clinical documentation special...

Revenue cycle leaders share approaches to keeping up with new codes and evolving payment guidelines during COVID-19. Understanding all that’s required to secure healthcare payment during a pandemic — especially for services related to COVID-19 — demanded that revenue cycle teams quickly refine denials management processes to protect their organization’s financial health. It also necessitated a spirit of patience and understanding toward payers, which faced a similar learning curve, according to Richard Madison, network vice president for St. Luke’s University Health Network in Bethlehem, Pennsylvania. “It takes two parties to get this right,” Madison said. While Madison and his peers encountered many obstacles that have complicated the task of denials management — including adapting to the needs of a remote workforce and dealing with the uncertainties surrounding payment for an unprecedented volume of telehealth services — their experiences also point to key factors in protecting reven...

In the aftermath of COVID-19, payment flexibility, digital engagement, and transparency are crucial to improving patient financial experience, recent reports show. In the wake of COVID-19, calls for patient financing flexibility, a shift to digital payment methods, and a need for increased bill transparency have providers changing course when it comes to improving patient financial experience. Two recent reports, one from Patientco and another by VisitPay , revealed new insights on the impact of the pandemic on patient financial behaviors and preferences. Both reports concluded that patients are more wary than ever about healthcare costs. “As the pandemic forced consumers to scrutinize their finances and prioritize which bills to pay, it’s become clear that health systems must offer flexible, tailored payment options to help patients manage medical bills in ways most convenient to them,” said Kent Ivanoff, co-founder and CEO of VisitPay, in a press release . VisitPay’s report compiled...

A new survey shows that staff shadowing preceding automation integration is disruptive to employees and has negative impacts on revenue cycle productivity. More than half of health systems found staff shadowing to be disruptive and to have negative effects on revenue cycle productivity, according to a national survey . The survey, commissioned by AKASA and conducted through the Healthcare Financial Management Association’s (HFMA) Pulse Survey program, included answers from over 350 chief financial officers and revenue cycle leaders at health systems across the country. Of the health systems surveyed, 68 percent had experienced staff shadowing. Revenue cycle staff shadowing typically happens ahead of implementing automation or other technology tools in order for consultants to document workflows and processes, according to the press release. About one-fourth (23.6 percent) of health systems responded that shadowing only captured a limited number of workflows and the documentation was of...