Capturing Maximum Revenue During COVID-19

Maintaining financial health is one of the most crucial (and complex) responsibilities of any care provider.

Since COVID-19 was thrown into the mix, the tasks of billing, collections, and revenue management have become even more challenging.

With the healthcare industry’s sudden pivot to remote care, capturing as much revenue as possible is perhaps more important than ever.

Of course, there is no blueprint for medical billing during a pandemic.

Billers and payers have been forced to figure things out on the fly. And billers and payers can both agree that blazing a new finance trail under these circumstances has not been easy.

Though it hardly feels like it, our industry now has a few months of experience in delivering care during COVID-19. The strategies and solutions available to a billing staff have certainly been improved to meet this unique challenge. However, there is still more work and refinement to be done.

To get a sense of the revenue challenges billers are facing right now, I spoke with Stephanie Edrington, our Finance Guru over at HealthPCP. Read on for her insight into overcoming those issues and achieving excellent financial health during this time.

Healthcare Billing and Collections During COVID-19

Due to the coronavirus, care providers are experiencing lower volumes of:

• Scheduled Appointments
• Billable Charges
• Claims
• Revenue

With less money to go around, capturing every last penny is even more critical than usual. Processing clean claims efficiently for maximum and timely reimbursement may be the difference in a practice remaining open and staffed during these times.

How can organizations get the most out of their limited opportunities for revenue?

If you ask Stephanie Edrington, it’s all about the software tools a billing staff has at their disposal.

And what’s the best tool for capturing maximum revenue during COVID-19?

The enterprise EHR.

In a healthcare system that has been fragmented by the virus, providers are best served by a platform that houses their entire operation (clinical, medical, financial, engagement) in the same system.

If we have learned one thing so far, it’s that software synergy and comprehensive integration are essential for billing success during the pandemic.

After helping many different providers navigate their billing and revenue cycle management these last few months, Stephanie recognizes that those essentials apply to every discipline.

She has identified 4 major issues caused by COVID-19 impacting healthcare billers:

1. Disrupted or Remote Work Environments
2. Lack of Software Integration
3. Missing Out On Revenue Opportunities
4. Payer Discrepancies

We will explore those issues and highlight the ways an enterprise EHR offers effective solutions for the unprecedented challenge of the pandemic.

Issue #1: Disrupted or Remote Working Environment

Coronavirus-induced disruptions have come in all shapes and sizes.

Providers have had to make changes due to state mandates/closures, developing safety protocols, office capacity guidelines, or simple organizational choices.

In many cases, these changes have caused billing staffs to transition to working from home. As a result, their system and normal processes have been put to a unique test.

Unfortunately, Stephanie has seen how some financial setups cannot be simply transposed onto a remote working environment.

Trying to manage financial health outside of the office has exposed gaps in many providers’ technology.

For example, some organizations have had to purchase remote desktop access services to get their office network to conduct billing tasks. These subscriptions can prove to be timely, costly, and ancillary expenses.

Furthermore, it forces providers to seek help outside of their current finance platform. Such reliance on external services hinders software synergy and also puts an organization at the mercy of another company’s technology.

These software gaps have reared their ugly head more frequently with customers who are using standalone RCM systems that don’t offer great connectivity and mobility features.

Enterprise EHR Solution: Mobility/User-Friendliness

If you do billing through an enterprise EHR, remote access should be a standard functionality. For most modern EHRs, access to your finance platform from anywhere at any time should not be an issue.

Laptops, tablets, even phones – you may be surprised how much billing you can accomplish outside of the office with the right enterprise software solution.

Take it from Stephanie – she admitted to checking claim rejections directly from her phone in her spare time.

Do we suggest this same billing dedication for all? Not necessarily – we don’t call Stephanie our Finance Guru for nothing.

However, we do wholeheartedly advocate for using an EHR that offers data with such immediacy and control.

Enterprise platforms likely offer user-friendly smart technology as well. This has become very important now that many billing staffs are working remotely.

A user-friendly EHR can help billers adapt to their different work environments, such as detecting new printers, scanners, and networks. In this way, the platform even protects against technical obstacles outside standard financial tasks.

An enterprise, end-to-end software solution will be rooted in intuitive technology, making both the act of billing and computing equally painless, no matter the setting.

Issue #2: Lack of Software Integration 

Are your EHR systems seamlessly integrated?

If not, you may have had some difficulties navigating multiple systems to complete billing tasks in your disrupted work environment.

For example, some RCM platforms require users to export certain files from other programs or export them from a specific computer.

Under normal circumstances, navigating several external programs to complete billing tasks can make things more difficult and less efficient. Those issues have been exacerbated at home.

Stephanie mentioned that some billers are struggling to maintain their normal performance while limited to a laptop working from home, as opposed to a desk and multiple monitors.

Having to use your EHR and billing software simultaneously to process claims may be feasible in that regular office setting – one screen per program. Take away that extra monitor, and the process gets much clunkier, more time consuming, and less mistake-proof.

A lack of software integration can also make it harder to have all the information you need at your fingertips. When you don’t, and have to go looking for data in different systems, you can lag behind as rules, codes, and policies evolve in real-time.

Billers may remember codes changing by the hour in the early days of COVID-19. Things have slowed down on that front, but there are still certain developments that change how billers must process claims.

If a billing staff is working in multiple systems, there is more of a chance that they miss out on these changes, which increases denials.

Another integration issue is telehealth. We have found that having a telehealth tool integrated with your EHR, and thus your finances, simplifies things immensely.

Alternatively, if the telehealth tool doesn’t “talk” to the rest of the EHR, the full continuum of care is not captured in one system.

Providers without an integrated telehealth tool have had to use third-party providers like Zoom, which has been associated with various security risks.

Other organizations took advantage of the lifted HIPAA telehealth restrictions, which allowed providers to conduct telemedicine visits via apps like FaceTime or Skype. This ruling was an effort to expand patient access to telehealth.

However, some patients have been wary of this option because it requires them to use their personal cell phone number and email for private medical consultations.

According to Stephanie, there have also been scheduling issues when providers are using an external telehealth tool.

In some cases, she has seen providers that have to schedule appointments in their EHR and an external video conferencing program. This double-scheduling adds opportunity for discrepancies or miscommunication as multiple parties may be referring to different schedules.

As a result, managing and completing claims can become more difficult. Billers are forced to check multiple schedules to complete documentation and make sure all charges are being captured.

If this sounds unnecessary and inefficient, it is! Stephanie has seen instances where billers are not aware that there are other claims hanging out on external programs, which has resulted in revenue loss.

EHR Solution: Enterprise Synergy

Providers are adapting to how to deliver care during this time, and their choices may not reflect an understanding or awareness of the challenges that billers may subsequently face.

With an enterprise EHR, no matter the direction your organization takes, the platform is there to support your plan of action.

There is no need to navigate between multiple external programs. Everything can be done in the same system, where intelligent workflows allow the necessary information to generate in the locations you need. There is no need to go looking for it.

As far as telehealth, we see it as an integral tool for any provider going forward. Remote video conferencing capability is going to be an industry standard soon, if it isn’t already.

When your telehealth platform is integrated with your larger EHR solution, you don’t have to worry about cumbersome and disparate scheduling or documentation. Instead, all staff from all departments have easy access to the same, up-to-date information to complete their tasks.

So not only is it beneficial to have that synergy now between your EHR and video conferencing platform, you are also setting yourself up for success in the future.

Issue #3: Missing Out on Revenue Opportunities 

Stephanie has found that many providers were under the impression that they could only bill for sick appointments via telehealth.

Instead, it is available for all specialties and all provider levels. It can be supervised and signed off on, and therefore, billed!

Even something that may seem as minor as a chiropractor discussing back stretches via telehealth has a billable code.

Being unaware of which services you can bill for is an avoidable problem. Providers that are unsure of this are probably using a system that does not organize and identify billable services.

In a landscape where billable services are farther and fewer between, capturing each one is very important.

Besides not being aware of the opportunities to bill for telehealth, there is also the matter of emerging rulings with retroactive billing implications that billers are not taking advantage of.

For example, Medicare has retroactively raised the fee schedule for reimbursement on telehealth services.

Medicare increased payments for telehealth services from a range of $14-$41 to $46-$110 going back to March 1, 2020. That is considerable revenue that providers have a chance to recoup.

Some providers will be happy with their reimbursement. Others may be unsure if they were reimbursed for every appointment if they don’t have good documentation (scheduling) and reporting.

With poor dashboards or reporting, it will be difficult to know if you’ve recouped all you can. Without a powerful finance tool, it may be difficult for providers to show how and when they were billing for each service in the past.

EHR Solution: Billing Workflows, Documentation, and Reporting

Effective finance platforms in powerful EHRs are powered by intelligent and intuitive workflows. Finance workflows provide billers with self-reconcilable, up-to-date carrier info. This has been especially critical during COVID-19 as guidelines and billing info has been in flux.

Quality EHRs should allow billers to view a patient on their EHR and look up their payer to find up to date info and carrier specifications and bill accordingly.

Providers can use features as a tool to explore what carriers are paying or not paying for and capture any service they can.

There are other finance workflows that help identify and organize telemedicine services. A comprehensive platform should be able to break them down by time interval and cost. This way, you can see the time interval on the note, which shows how much to bill for.

Lastly, enterprise EHRs will offer you the documentation to keep easily accessible records for these timely reimbursement remittances, such as Medicare’s ruling. As well as the reporting to provide proof of service.

Issue #4: Payer Discrepancies

The pandemic has been hectic for payers, too. From what Stephanie has seen, the biggest issue has been communication.

Insurance carriers will announce and institute a new change, but they may not have updated their records or computer systems or told their call centers.

In other cases, the payer’s own staff have not been up on the policies as they update and thus process claims incorrectly.

These carrier discrepancies have caused a lot of confusion, phone calls, and time to correct a claim that the payer processed incorrectly.

For example, Stephanie recounts one instance where two claims were submitted for two patients with an identical policy (the same modifier). The carrier paid one but denied the other.

EHR Solution: User-Friendly Claims Creation

As the pandemic persists, financial workflows that automate the claims creation process are crucial. They provide critical assistance in creating claims and following up on rejected claims.

In this specific instance where payers may not be 100% reliable, a platform that allows billers to monitor rejected claims in real-time can be a game-changer.

An enterprise EHR’s finance system should be able to organize rejected claims in a highly visible interface, such as a dashboard, that makes corrections easy.

Ideally, an electronic denial code will be sent back to your billing dashboard immediately. Be mindful that this process requires easy integration with the clearinghouse, though this should be a standard for enterprise EHRs.

The alternative would be waiting for a paper denial. Normally, paper denials can take up to two weeks to arrive at an office after the clearinghouse sends them back. As you can guess, waiting on a paper denial can be even less efficient when staff is working from home.

With a robust system powered by intelligent financial workflows, a billing staff can get a rejected claim corrected, sent back out, and approved to be paid before a paper denial even arrives.

Maximizing Revenue During COVID-19

Is your organization currently experiencing any of these revenue issues?

If so, it might be time to reevaluate your billing platform.

Though it may seem counterintuitive, it is actually the perfect time to convert to a new software. Providers have more time than ever to adjust, perfect, or convert to a new system.

While volumes are lower, these things can be taken care of with limited disruption and downtime. This is an opportunity to focus, customize, set up, and build your system in the ways your operation deserves.

In fact, Stephanie has seen this firsthand.

During the pandemic, she has transitioned two organizations from a different billing system to AURA Finance, Sigmund’s billing platform. Their original system was too cumbersome to handle the obstacles while working from home. AURA provides the software synergy that can transcend the limitations of a remote work environment.

AURA’s finance features are seamlessly integrated into the larger platform, with intelligent and automated links between all clinical, operational, engagement, and financial functions.

Stephanie stresses that, when it comes to capturing revenue during COVID-19, configuration is key.

Lesser systems run the risk of not being configurable enough. There are too many platforms, whether an EHR or a standalone RCM software, that have a single functional setup. As a result, users are forced to fit their processes into the software’s box, rather than having the software facilitate their process.

AURA provides flexible configuration to adapt to pandemic developments, without overriding your standard processes. For example, being able to create additional, temporary policies and contracts is a huge advantage to current and future functionality.

Stephanie also emphasized the need for a billing staff member to stay up to date with the CARES Act so that your organization can take advantage of all the resources that are and will become available.

Organizations that stay current with the CARES Act have been able to take advantage of various relief efforts as soon as possible, such as the recent telehealth stimulus package. Note that the telehealth stimulus package has almost run out, but there are still flexibilities to get the last of stimulus support.

If you have been experiencing any of the issues we discussed, we hope you have a better idea of the solutions available to you.

For further billing guidance, check out this Behavioral Health Biller’s Toolkit. We outline the 4 most important EHR tools for behavioral health billers in general. You may find more answers to your current problems in there, too.