COVID-19 results in changes to healthcare revenue cycle management. Here’s why.

Erin Head

Without a doubt, the COVID-19 pandemic has sent shockwaves throughout the healthcare industry; and this includes revenue cycle management in healthcare. As healthcare organizations work to bounce back from the pandemic’s impact, the recovery process will likely extend well into the future.

When the first discussions of the pandemic impact began in healthcare organizations, the plan was set- inventory resources, conserve and stockpile resources, and clear the path for a potentially critical patient surge. Unfortunately, this meant high revenue generating elective procedures and routine care visits were instantly put on hold to conserve those resources for COVID-19 patients. As hair salons, gyms, and other “non-essential” businesses began shuttering their doors, healthcare professionals braced for impact- clinically and financially.

If you had thought of a virus with a public health impact such as COVID-19, you may have instantly thought that hospitals and healthcare organizations were going to be an essential business indefinitely. Instead, this pandemic resulted in a stark and abrupt drop in healthcare generated revenue. Healthcare organizations have seen, on average, a 56% decline in patient volumes since the COVID-19 pandemic began to affect the United States. Some regions were hit very hard while others maintained plenty of capacity for a potential patient surge, but the average impact to the United States healthcare system is enough to generate an audible gasp.

To put this into perspective, let’s say your revenue cycle management plan involves a team of professionals who process each claim manually and now patient volumes are reduced by over 50%. Your staffing plan must be swiftly adjusted to stop the bleeding cash flow that is lacking matched revenue generation. Imagine that all Emergency Department (ED) visits are coded at a set productivity standard and the ED visit volumes are reduced by half for a sustained period of time, your coding staff must subsequently be reduced by half and this must be done immediately. The same applies to patient registration, billing, collections, and follow-up teams; a reduction in claims leads to a reduction in staff. This leads to the questions on all of our minds: How long will these adjustments be in place? Are they permanent changes? Will the staff be willing or allowed to return to work in the same capacity? Should contracted services be terminated or used exclusively?

Now imagine that the pendulum could swing in the opposite direction leading to a surge in patient volumes of postponed elective procedures and overdue provider visits. Even if volumes are restored to 80% or even 100% capacity, revenue cycle teams may still be staffed to (or only able to afford) the reduction in volume. Now what?

Healthcare as an industry has been progressively developing and investing in tools to help healthcare professionals work smarter not harder; especially within the revenue cycle. Exploring and investing in the technology to improve manual processes and increase productivity is long overdue. But it’s not too late to rethink automation’s role in the revenue cycle and really stretch the legs of this technology.

A rapid revenue cycle turnaround on new claims is vital to rebuilding the healthcare system and workforce. There are plenty of tasks that are performed repetitively that can be enhanced and transformed using automation, artificial intelligence (AI), and natural language processing (NLP). Some of these tasks include diagnosis and procedure coding, data reporting, document imaging, release of information, code edits, and claim scrubbing. Patient scheduling and registration could utilize self-service automation that leads to a more efficient and customer-centric process. Some of these processes can be automated permanently ultimately restructuring the staffing impact for the future and further acceleration of the recovery process. At times like these, we are all forced to be nimble and adaptive but we don’t have to sacrifice quality. This new reality may be with us for a while and workflow automation will assist in restoring healthcare revenue cycle operations.



More in Healthcare