Revenue Cycle Management in a Post-Pandemic Era

COVID-19 may have caused an upheaval in your RCM operations — but sometimes upheaval is a good thing.

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For revenue cycle management (RCM) professionals, the pandemic highlighted inefficiencies and workflow problems in current systems. Providers had to quickly adopt or increase their usage of digital technologies, such as videoconferencing, telehealth platforms, and electronic health records. Medical billers and coders also had to learn how to manage new technologies and processes while working remotely.

Pre-pandemic RCM

Prior to the pandemic, many providers still used at least some paper documentation and hadn’t fully embraced digital technologies or electronic health records (EHR). Telehealth and videoconferencing technologies were available but not widely adopted. Medical coding was mostly manual. Providers often used more than one RCM partner. And, often, RCM was not integrated with their EHR. Processes probably seemed a lot simpler back then, but they were time consuming and labor intensive. Then the pandemic changed things up.

Post-pandemic RCM

When the pandemic struck, healthcare and RCM changed almost overnight. Canceled appointments and a lack of elective procedures accompanied a drastic drop in provider revenue. Out-of-work patients had a difficult time paying their medical bills, and provider organizations needed to use customized patient-friendly billing procedures to accommodate patient circumstances.

Revenue drops caused providers to reduce RCM staff, despite increased workloads. Unfortunately, these circumstances led to burnout and further staff shortages. In-person patient visits pivoted to phone or electronic consultations, with telehealth platforms rising as an essential solution. For medical coders and billers, this meant not only adjusting to remote work, but also determining how to code and bill for telehealth and electronic consultations.

Email, text, and patient portals became important methods of patient-provider interaction. And because paper documents created a risk of COVID contamination during handling at various touch points, EHR relegated paper documentation to the background. In short, providers and RCM personnel had to learn to navigate this new digital world. Not only did these necessary changes help healthcare teams and their patients persist through the pandemic, but many of them remain in use today, even as the pandemic winds down.

The future of RCM

The revenue losses that occurred as a result of the pandemic are still felt today, making RCM optimization crucial for provider organizations’ ability to stabilize and improve their financial performance. RCM tasks, such as coding, billing, insurance claim processing, claim submission, and denial rectification, can be draining on the medical staff’s time — not to mention the organization’s budget.

It’s important to conduct an audit of your RCM processes to discover inefficiencies and redundancies that may hinder your RCM and make changes to correct them. If coding is slowing your cycle, automation may be a good solution. Additionally, you may choose to outsource your coding to a partner that specializes in that activity. It’s often more efficient to consolidate your RCM with one partner whose solution is compatible with your EHR or is EHR-neutral. Most integrated RCM systems are cloud based, so there’s no need to purchase, install, and maintain expensive equipment.

Telehealth provided much-needed relief and access for both providers and patients during the pandemic. Today, many providers continue to offer telehealth as an option for patients. Artificial Intelligence (AI) and machine learning (ML) also have become valuable technologies in optimizing RCM. These technologies quicken insurance benefit verification and reduce data entry errors, thereby streamlining RCM workflows. Moreover, they can be used for predictive analysis to improve patient outcomes and help payers with risk-based contracts.

Although everyone is relieved to see a lessening of the COVID-19 threat, the pandemic undeniably provided new opportunities for healthcare teams — namely, it accelerated the adoption of new technologies and RCM improvements that would likely still be in the planning stages. To optimize and futureproof your RCM efforts, consider partnering with TruBridge.