How COVID-19 has Affected the Healthcare Revenue Cycle

How COVID-19 has Affected the Healthcare Revenue Cycle


The novel Coronavirus took the world by surprise, from businesses to schools, and many people were compelled to stay at home, wear a mask and practice social distancing. Being a viral disease, both the acute and chronic patients were asked to avoid unnecessary visits to healthcare facilities, and most of the treatment was done virtually or by sending health teams to homes.

Many of the hotels, sports arenas, and park spaces were converted to makeshift hospitals, and the capacity and capabilities of healthcare centers have been tested to the limits. Both the management and healthcare providers seem to be at a loss to control the number of cases that keep on rising with each passing day.

The Covid-19 virus broke out in the Wuhan province of China at the end of 2019 and, throughout 2020, has infected almost 50 million people worldwide with over 1 million deaths according to recent numbers.

The Growing Healthcare Challenges due to Covid-19

Of all the countries, the United States seems to be the most affected country, with almost 10 million cases. The healthcare system is heavily tested all across the country, and healthcare centers face difficulty managing numerous challenges that include not only delivering quality care to patients suffering from acute and chronic diseases but also Coronavirus and taking steps to minimize the virus spread.

The biggest challenge for hospitals, medical practices, and clinics is financial stability due to

Canceled appointments and surgeries
Costs on purchase of personal protective equipment (PPE)
Increased workloads and confusion regarding medical codes selection amid Covid-19
Falling staff productivity due to a shift in work and priorities
Denied medical claims
Decrease in staff and workers due to layoffs and staff reduction amid cost cutting measures

According to the American Health Association (AHA), the total losses to healthcare centers due to Covid-19 is estimated to be over 300 billion in 2020. The revenue cycle is an essential component when it comes to managing the finances of medical practice.

The Need to Address the Healthcare Revenue Cycle

The revenue cycle is a process that allows a medical practice to effectively manage the administrative and clinical tasks ranging from patients appointments, to claim processing and submission to insurance providers, payment collection, and healthcare provider reimbursement.

If the revenue cycle is not streamlined, then a medical practice cannot provide the necessary treatment and care to the patients, cannot provide the healthcare practitioners' wages, and find it challenging to manage the cost of overheads and equipment.

On the whole, healthcare centers have to redefine their strategies and implement robust methods to adapt to the post-pandemic situation. Some of the solutions include telemedicine or telehealth, automation, and introducing digital software solutions to manage medical billing, claim processing, and revenue generation. Implementation of purposeful technological solutions such as innovative ‘Revenue Cycle Management Software’ is the need of the hour and prevent the losses to exceed when the anticipated second wave of Covid-19 comes.

Appointments and in-patient treatment procedures are two of the vital aspects of revenue generation. They account for nearly 50% of total payments but which unfortunately saw more than 90% decrease during the early stage of the Covid-19 outbreak as people were forced to stay at home to avoid the virus from spreading due to human contact. Resuming in-patient procedures and cutting costs is key to generate revenue and balance the financial losses.

The Emergency Department (ED) visits are coded according to a particular standard, and as ED volumes have reduced by half, then the coding staff must also be reduced to manage the cost and cash flow. The same tactic applies to a reduction in patient registration, billing, and collection staff. Medical practices will further complicate when the in-patient volume starts to increase after the Covid-19 cases settle, and the practice will be understaffed to handle the workload pressure.

The Significance of Implementing Revenue Management Software

Most of the population rely on insurance plans and coverages when it comes to seeking healthcare facilities. But the Coronavirus has changed the healthcare industry's complete dynamics as millions of individuals will be deemed uninsured due to job losses due to the pandemic. The loss of insurance will change the patient billing process of most healthcare centers. The solution lies in the automation and implementation of digital technology to improve productivity and streamline tasks.

Medical practices need innovative medical billing software that can easily integrate with the existing system and reduce the effort and resources needed to check the patient insurance plan status and availability. There is a particular focus on the self-pay patient accounts, which refers to the patients paying themselves for either the diagnosis, medical or surgical procedure. The self-pay patient billing strategies will help medical practices to get timely payments in times of economic downturn.

PETTIGREW has innovative RCM (Revenue Cycle Management) and billing software solutions with a wide variety of healthcare organizations. The company employs qualified and skilled software developers, billing and coding specialists who have the necessary knowledge that work in sync with the medical practice's unique needs.

Custom-built billing software will ensure faster claims processing, fewer errors, and fewer claim denials. A medical practice can streamline its processes effectively, and staff can focus on other key health facilities rather than spending time and effort on patient registration, medical coding, claim to process, and resubmitting denied claims. The advanced value-added feature includes remote coding services, audit and compliance, payer connect, and reporting and analytics.

The Advantages of RCM Software

With sophisticated and diverse software, the patient payment plans can easily be integrated, helping with payment collections in pandemics. Covid-19 may have drastically upended the entire healthcare system, but it can be a starting point of the much-needed change. The future of healthcare surely depends on an extensively interconnected, robust, flexible, and technologically advanced digital system.

The smaller medical practices and physician clinics have limited financial resources and need all the technological help to sustain and provide the care services to the patients. With changing healthcare dynamics, the medical codes are also revised, and CMS (Centers for Medicare & Medicaid Services) introduced a new Healthcare Common Procedure Coding System (HCPCS) codes related to Covid-19 testing and treatment.

The medical billing software is quite advanced and easily updates and complies with the changing HCPCS or CPT (Current Procedural Terminology) codes and saves the coder's trouble remembering or going through hundreds of different codes. Accurate medical codes are imperative for timely reimbursements as more than 50% of the claims are rejected due to incorrect codes on the medical claim.

Fast claim turnaround time is essential to rebuild the healthcare system, and there are so many repetitive tasks that can be managed efficiently and without any errors by automation, use of software, and Artificial Intelligence (AI) solutions.

Some of the significant tasks that will be managed effectively due to RCM software are patient scheduling, diagnosis, reporting, code selection edits, and claims scrubbing. The automation of tasks will also lessen the impact of employing low staff, and it will also reduce the chance of any error in claim processing and submission.

  • As the proper vaccine or cure of Covid-19 is still in the development stage, healthcare organizations need to have a proactive approach and partner with technology companies to use digital solutions to address the challenges and maximize productivity and revenue generation. Schedule a free consultation with our experts today to ensure your healthcare revenue cycle is professionally managed with HIPAA complaint staff to manage your entire RCM seamlessly, ensuring timely collections and 95%+ accuracy levels.