COVID-19 has put an enormous financial strain on physician practices. Many had to shut down or severely restrict the number of patient visits. Although telehealth did help, it also introduced new billing and claims processing complexities. Having good revenue cycle management (RCM) processes will be key as healthcare recovers from the pandemic.
I sat down with David Cohen, Chief Product and Technology Officer from Greenway Health to talk about the importance of RCM.
No One Wants to Talk About Revenue
Even in the best of times, healthcare revenue is not something that many want to discuss. I believe it’s because revenue is closely tied to billing. The former is necessary for physician practices and hospitals to function. The latter is what causes patient angst on the mild end of the spectrum and outrage on the other end.
We have all heard horror stories related to billing and perhaps that is why healthcare insiders avoid talking about their own financial health. That is truly a shame, because right now, it is more important than ever that healthcare providers take a hard look at their finances to ensure they have a solid foundation as we start to emerge from COVID.
Busting a Myth
As the pandemic stretched into months, there was growing concern that smaller physician practices would shutter because of the decline in patient visits. There were many musing on social media and in the press about how the loss of these practices would exacerbate the problem of healthcare access.
Over the last few months, however, I have not been able to find many people willing to go on record to discuss the decline in physician practice revenues and the potential devastation of primary care. Thankfully, Cohen provided some first-hand insight into the situation: “We simply haven’t seen any evidence of widespread closure of physician practices due to financial hardship.”
The reality is that many patients did in fact go to see their doctors during the pandemic, when the doctor deemed it medically necessary for an in-person visit.
Telehealth also played a part in helping to sustain physician practices during the pandemic – allowing doctors to continue seeing their patients through voice and video technology. However, telehealth also introduced new challenges when it came to billing and processing claims.
The Need for Good RCM Practices
Throughout our conversation, Cohen stressed the importance of having a trusted partner to help physician practices navigate the wave of changes to RCM brought on by COVID.
Here is an example of a new workflow + coding guidelines related to COVID-19, published by the American Medical Association (AMA):
This is just one of 26 COVID related scenarios outlined by the AMA!
Every new scenario is a new workflow for physician practices. Every new workflow leads to new payment rules and guidelines. The combination of telehealth and COVID-19 has resulted in tremendous change to the way encounters are documented, coded, and ultimately reimbursed.
Now imagine what happens when the COVID-19 vaccine becomes widely available.
This added complexity due to COVID-19 is why Cohen is so passionate about physician practices needing to have good RCM skills and processes. Fewer patient encounters means it is more important than ever to avoid unnecessary delays in payment and unnecessary work resubmitting claims.
Greenway has been hard at work helping their customers traverse this changing RCM landscape.
Greenway Revenue Services
Cohen shared that the Greenway team has been focused on keeping up to date with new payer rules and ensuring practices capture revenue for the services they provide.
Greenway even recently launched a new product – Greenway Revenue Services Express (GRS Express) – which helps organizations with post-claim submission, rejection management, and ensuring providers are reimbursed and collecting payments. Unlike traditional RCM services, customers can be up and running with GRS Express in as little as two weeks.
“We want to support customers with our Greenway Revenue Services so that they can focus on what they do best – providing patient care,” said Cohen. “We can take care of the revenue cycle back office for them.”
Greenway has also been busy investing in a new data and analytics platform in partnership with Amazon Web Services (AWS). This will help Greenway serve provider organizations with new revenue cycle insights while providing access to some of AWS’s machine learning capabilities.
Cohen is looking forward to taking data analytics to this new level. “We need to take the focus on current state a step further,” he said. “How are we going to be trending and what does my cashflow look like a week from now or two weeks from now?”
V-shape or W-shape Recovery?
During our conversation, I asked Cohen a question that has been on the minds of many: what shape will the COVID recovery take? “People are wondering if this [the COVID economic recovery] is going to be a V-shape or a W-shape,” said Cohen. “From what we have seen, it’s really been a V.”
I hope he is right.
Watch the full interview with Cohen to hear about:
- The new 2021 CMS payment rules and the effect they will have on revenue cycle management
- How the rush to adopt telehealth has created new backend problems for revenue cycle management
- Why it’s important to have a good understanding of your current KPIs for continued growth
- The importance of understanding both provider and patient financial situations and hardships
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