Revenue cycle leaders share approaches to keeping up with new codes and evolving payment guidelines during COVID-19.

Understanding all that’s required to secure healthcare payment during a pandemic — especially for services related to COVID-19 — demanded that revenue cycle teams quickly refine denials management processes to protect their organization’s financial health. It also necessitated a spirit of patience and understanding toward payers, which faced a similar learning curve, according to Richard Madison, network vice president for St. Luke’s University Health Network in Bethlehem, Pennsylvania.

“It takes two parties to get this right,” Madison said.

While Madison and his peers encountered many obstacles that have complicated the task of denials management — including adapting to the needs of a remote workforce and dealing with the uncertainties surrounding payment for an unprecedented volume of telehealth services — their experiences also point to key factors in protecting revenue cycle performance during a crisis.

Revising early expectations

When the world changed in March 2020 with the emergence of the coronavirus in the United States, revenue cycle leaders at Sharp HealthCare in San Diego thought they could take advantage of reduced volumes to strengthen days in accounts receivable (A/R).

“The message at that time was that payers were ready to support providers during the pandemic and ensure cash flow, so we had strategic discussions around ways to come out of the pandemic with squeaky-clean and current A/R, resolve older claims and make the best use of reduced claim volume,” said Gerilynn Sevenikar, vice president, revenue cycle, Sharp HealthCare.