Revenue Cycle at Forefront of Organizational Changes
At hospitals across the United States, administrators had to quickly create effective processes to separate COVID-19 patients from other patients. At Emory Healthcare in Atlanta, revenue cycle leaders were closely involved in this.
“I’ve been working with a legacy system I support to modify and/or reconfigure a number of units to accommodate patients with various acuity levels,” reports Peter Kraus, CHAM, CPAR, FHAM, business analyst for revenue cycle operations. These two issues became important:
- How to change the default accommodation code of a bed or unit from private to intensive care unit to address the anticipated acuity of patients who will cohort there;
- How to ensure accounts eventually will be billed correctly to reflect patient treatment. “We have lots of beds and units at our hospitals, and lots of leaders with new ideas of how to cope,” Kraus explains.
Revenue cycle leaders also are involved in the patient population reporting side. Kraus says there are two main questions: How can staff accurately identify the COVID-19 population in general? What about various subpopulations (e.g., patients taken from cruise ships and sent to a local Air Force base for isolation, and were admitted to the hospital)?
The department added COVID-19-related CPT/HCPCS codes. At least some payers, possibly including Medicaid, will require these. “But it’s too early to know how the billing process will evolve when we get through the worst of the pandemic,” Kraus notes.
While billing and reimbursement are critical to the financial viability of hospitals, Kraus says current efforts are focused on identification, containment, and treatment of patients with the virus, as well as protection for care providers. “If front-end identification and accurate documentation facilitate the billing process, so much the better,” Kraus offers. “But at this stage, it is secondary to many more important matters.”
At Spectrum Health in Grand Rapids, MI, patient access adapted quickly to the COVID-19 pandemic. “So far, most of that change has been related to our contact center,” says Maria H. Kamenos, CHAM, CHFP, vice president of patient access services.
In the early days of the crisis, patient access was asked to set up an internal information line. Clinicians and operational leaders use it to connect with nurses trained to answer questions about COVID-19. “This line was set up to support our infection prevention team, who were already fully engaged in responding to the situation,” Kamenos explains.
Patient access staffed it using the primary care nurse triage team from its contact center. “As we began to cancel elective services and ambulatory clinics, we simultaneously created COVID-19 virtual screening capabilities,” Kamenos notes.
Patient access quickly created a 24/7 scheduling line for this service. “We redeployed team members from all over the organization to staff this line,” Kamenos reports.
This included more than 400 physicians who perform the actual screenings. During the first three weeks, staff took more than 24,000 calls. “We have scheduled over 17,000 telephone screenings for patients across Michigan and 27 other states,” Kamenos adds.
Patient access also is responsible for scheduling and check-in of patients accessing drive-through COVID-19 testing tents. “We also have a dedicated phone line for employees who have symptoms that need further investigation before they can safely be cleared to work,” Kamenos says.
Hospital-based registration and financial counseling teams are acting as screeners at various checkpoints to ensure no symptomatic people enter the hospital. “As we initiate plans for overflow beds — and, potentially, new sites for stable patients — we will provide registration support in those locations as well,” Kamenos says.
At hospitals across the United States, administrators had to quickly create effective processes to separate COVID-19 patients from other patients. Revenue cycle leaders have been closely involved in this.
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