4 Revenue Cycle Initiatives Fast-Tracked by COVID-19

Projects on the backburner, like having a remote workforce, paperless patient communications, and electronic signatures, have been implemented faster out of necessity.

This article appears in the July/August 2020 edition of HealthLeaders magazine.  

For years, revenue cycle executives have talked about modernization wants and needs. But in many healthcare organizations, a lack of time, money, or will—or all three—have stood in the way of moving forward.

The COVID-19 crisis has changed that, and projects on the backburner have been implemented faster than anyone thought possible out of necessity. Instead of languishing on a wish list, projects like having a remote workforce, paperless patient communications, and electronic signatures, have suddenly come to fruition.

Thirty-one revenue cycle executives convened virtually to discuss these and other issues during HealthLeaders' Revenue Cycle Exchange Web Conference on May 4.

"There are a couple of things that we've really accelerated for COVID reasons," Joann Ferguson, RN, BSN, MBA, vice president of revenue cycle for Henry Ford Health System in Detroit, said during the conversation. "We were able to … get some things done much quicker than perhaps we would have moved [on] prior to this."

For instance, they've made strides in using accommodation codes for patients boarding in the ED to capture inpatient and observation charges.

"We had kind of stalled on that and COVID expedited that to make sure we were capturing charges where we had introduced new throughput issues and a rapid need to create new units … due to COVID capacity," Ferguson said.

Here are four other revenue cycle initiatives that leaders have pushed through during the COVID-19 crisis.

1. Going paperless: At Henry Ford Health System, there were still some parts of the medical record that people were either hesitant to make electronic or hadn't gotten a chance to make electronic yet, like its patient consents. However, the system's COVID-19 contamination strategy accelerated that process (with help from waivers that allowed verbal consents) and eliminated several perceived barriers.   

"Our paper would leave our hospital building, go to an outsourced area for scanning and then come back to us for QA [quality assurance] checks," Ferguson said. "We had seven touches on some of our pieces of paper before they were in the medical record."

Since that was too many touches while trying to contain a highly contagious virus, they "very quickly" switched to electronic records where possible. Similarly, they were able to expedite the use of electronic and verbal signatures for consent.

Miriam Flores, executive director of patient business services at The University of Texas MD Anderson Cancer Center in Houston, described a similar situation in which they were able to develop a PHI-secure method for some of its previously outsourced claims printing.

2. Removing siloes: Although the revenue cycle is supposed to run like a seamless assembly line, many departments from the front to the back end haven't operated as cooperatively as leaders may like.

COVID-19—and working remotely—has helped to break down those barriers.

"One of the successes, interestingly enough, is we've turned issues that used to be siloed—like chargemaster issues, deciding what revenue code to use—and we've made it much more of a group discussion about the issues," said Michael Berger, director of revenue cycle​ for Saint Peter's Healthcare System in New Jersey. "It really added to the cohesiveness of the group."

He said his group feels connected and regularly touches base to work through issues and ideas together, with less of a worry that they'll make the wrong choice because they're making a decision on their own.

Other Exchange participants described similar experiences of regular interdepartmental meetings, team huddles, virtual chats, and video calls using platforms like Microsoft Teams and Webex.

Bruce Preston, director of revenue integrity for Grady Health System in Atlanta, says they have a weekly meeting of revenue cycle leaders from every department.

"Every department in the revenue cycle is represented so that everyone is on the same page and we all know what's going on within the revenue cycle with whatever changes are coming up," he said. "Whether it be billing indicators, or the way we're not going to bill patients for a COVID lab test."

3. Cross-training: Last month, Jonathan Wiik, principal of healthcare strategy at TransUnion Healthcare told HealthLeaders that revenue cycles should consider reallocating and cross-training employees, such as billers or registrars in clinics where patient flow has slowed down, to ensure that staffers are ready to meet the demand when surgical rescheduling is needed.

Yet that's already happening even beyond surgical rescheduling.

Ferguson says that thanks to a new work driver tracker created by Henry Ford's analytics team, she's been able to track and respond to how COVID-19 has changed the revenue cycle's work and adjust staffing as needed. For instance, telemedicine volumes that were once low have now skyrocketed.

"It helps me to deploy my staff appropriately," she said, such as moving procedural coding employees to working on telephone visits instead.

4. Remote workforce: Of course, the most significant change that COVID-19 has expedited is moving most of its workforce to a remote working environment. And they have done so quickly.

Ferguson says whereas 70% of Henry Ford's revenue cycle workforce was remote pre-crisis, 96% of it is remote today. Within a week of Detroit's first COVID-19 case, they were able to move the rest of the revenue cycle employees home.

Exchange participants said some revenue cycle employees still work on-site, like those with patient-facing roles and those whose jobs involve scanning paper, such as birth and death certificates, for instance.

However, even jobs that leaders were skeptical about being done remotely are proving to be successful. Flores points to MD Anderson's customer service call center employees as a prime example.

 "I was dubious and that was primarily because of the technology," she said.

She said it took more specialized equipment—including new headsets—and cost about $3,000 per customer service employee to deploy them home, but it's been worth it.

"It's actually worked out very well," she said.

Fewer sick calls and increased productivity are other remote workforce perks, say leaders, some of whom are contemplating whether certain roles will ever move back to the office.

Stay tuned in the coming weeks as we share additional insights from conversations from the HealthLeaders' Revenue Cycle Exchange Web Conference.

The HealthLeaders Exchange is an executive community for sharing ideas, solutions and insights. Please join the community at https://www.linkedin.com/company/healthleaders-exchange. To inquire about attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com or visit our website for more information.