As a result of the COVID-19 public health emergency, many healthcare institutions are struggling with cash flow. Elective procedures have been postponed and non-critical patients are electing to stay home rather than seek treatment. Hospitals facing a cash crunch can maximize cash flow through their EHR and other operational initiatives. Here are six things you can do right now to improve cash flow during these challenging times.
Ensure eligibility for CARES Act Provider Relief Fund
The U.S. CARES act provided $50 billion in relief funds to healthcare providers during the COVID-19 public health emergency. These funds are distributed based on the provider’s share of net patient revenue. To obtain these funds, providers must submit revenue and cost information to the department of Health and Human Services (HHS). If your organization does not submit this information from your EHR on a regular basis, do so as a high priority to access these funds. The HHS fact sheet has more details and links to submit.
Submit Uninsured COVID-19 Claims
During the COVID-19 pandemic, any COVID-19 testing or treatment of uninsured patients will be reimbursed by HHS at Medicare rates. Use the EHR reporting tools to identify these encounters and submit them quickly to increase cash received. More information and submission instructions can be found on the fact sheet.
Follow Best Practices and Reimbursement Guidance for Telehealth Visits
As part of new regulations around COVID-19, Medicare and many commercial payors reimburse telehealth visits at the same rates as in-person visits. Many organizations have expanded telehealth visits to safely serve patients. Follow best practices for conducting telehealth visits and securing data. HIPAA restrictions have been relaxed during the public health emergency to give more options when choosing technology to support telehealth visits.
In addition, make sure your expected reimbursement calculations reflect the in-person rates when you complete a telehealth visit, instead of the previous telehealth rates. If this is not updated it will cause incorrect financial projections and heavy additional work for the billing office.
Identify Low-Hanging Fruit in Unbilled Claims
Addressing low effort but high dollar unbilled claims is always a good way to increase cash but it becomes more important during a challenging financial environment. Look for Discharged-Not-Final-Billed accounts with only one billing edit; these can be quickly resolved and submitted for payment. Consider removing some of your EHR’s normal billing edits, especially those holding accounts for additional charges. Many inpatient accounts are paid by case rate or per diem; holding billing on these accounts will delay cash received with no financial benefit. If your organization performs manual charge review, consider removing these holds as well so claims can be sent more quickly.
During the COVID-19 public health emergency, government and commercial payors are waiving authorization requirements for any patient suspected to have COVID-19. Ensure your EHR does not prevent billing these accounts due to missing authorization.
Resolve Outstanding Denials and Underpayments
Denials and underpayments are known opportunities to increase cash without increasing clinical volumes. Have your billing office focus on resolving these items quickly so new claims can be sent. If you use an EHR such as Epic or Cerner, many claims can be adjusted automatically and released if you identify root causes of denials. Consider creating a denials team to perform this investigation if you do not already have one.
Offer Prompt Pay or Pay-In-Full Discounts
Most organizations have a large volume of outstanding self-pay balances. To increase cash during the COVID-19 public health emergency, consider offering prompt pay discounts to these patients to incentivize timely payment. If you do not already do so, set guidelines for payment plans as well. With these two tools you can proactively reach out to patients and ensure these balances are collected while providing good customer service.
While health systems are threatened with new financial challenges, there are strategies to get your organization through tough times. In this time of crisis, you have to plan and get creative to get through the cash-flow crunch.
Article co-written by Nicole Ranere, Manager of Revenue Cycle HIT.