COVID-19 has forced many organizations into increased remote work, possibly before we are ready, and for roles that have not traditionally had the opportunity or infrastructure to work remotely. However, looking ahead, this may be the new normal. Implementing a virtual business office strategy that both responds to immediate needs while also charting your course for a sustained telecommuting workforce in the future will be critical for success.
In some ways, we can use lessons learned during the country’s preparation for ICD-10 in 2014. For example, the need to dual-code accounts created an influx in demand for coders, which led to an increase in remote staff. We also needed to assess our documentation and coding to ensure appropriate specificity and to find the specialties where we had the most opportunity to maximize our documentation and coding of our reimbursable services.
As part of the current pandemic, you’re likely rapidly transitioning the business functions within your revenue cycle to a remote-based workforce. You’re also shifting pre-service work from physical visits to virtual care and elective services to COVID-19-response services. Meanwhile you’re shifting back-end work from steady accounts receivable (A/R) throughput activities of elective services to maximizing net revenue of existing and past gross receivables.
This rapid response to a virtual business office comes with a host of competing priorities and challenges. That’s why we’re sharing helpful insights on how to maximize both staff productivity and happiness and also maximize net revenue on declining gross revenue during this difficult period.
Prioritizing activities in the short term (during pandemic)
One side effect of the pandemic for most organizations is a decrease in elective volumes, including surgeries, ancillary services, and preventive care. This, of course, has a negative impact on revenue and subsequently cash. At the same time, this creates capacity for billers and follow-up staff. It’s important to leverage this time to work on additional cash-generating activities to help bridge at least a portion of the cash shortfall that is coming or has already occurred.
While not a comprehensive list, here are some opportunities to consider that can improve net revenue during a time when gross revenue is declining:
- Begin transitioning staff from denials/appeals to underpayments of previously paid elective claims.
- Conduct a late charge review of billed claims. This may be an appropriate time to review your late charge policy and consider if lower expected reimbursement thresholds should be considered for rebilling claims.
- Focus on working down any unbilled/candidate for bill (CFB) backlogs to bring in cash from claims that are still being held due to internal processes.
- Consider changing self-pay follow-up objectives to focus on “flipping” self-pay balances due to patient responsibility/coordination of benefits denials through “coverage discovery” workflows. Partner with patients during outbound calls to shift from “patient collections” to “patient advocacy” workflows. For example, follow up with commercially insured patients to complete outstanding third-party liability questionnaires related to accidents and injuries for accounts that may have simply been written off under normal circumstances.
In addition, your ability to help staff take effective follow-up action will be limited if work has been moved to remote settings. You will need to be proactive in ensuring quality payer interactions by providing appropriate appeal letter templates, call scripts, and job aids to support payer follow-up and appeal workflows. This will also be important in the long term.
So now that you’ve identified what staff should focus on and the job aids they need to be effective, how can you help everyone get through their day in these challenging times? And importantly, how will you know what they are doing?
Adapting activities for flexible work-hour needs
In “normal” times, it’s important to expect remote employees to keep regular hours and have an appropriate office space where they will not be interrupted by children and pets. In the exceptional circumstances created by COVID-19, schools are canceled, children are at home, and there may be other adults working in the home. In the current reality, your staff may not have the ability to work in ideal conditions.
Work with your human resources department to define policies that work for your organization and encourage employees to create a work environment separate from the rest of their home.
Where flexibility can be allowed, it will be important to prioritize work to capitalize on regular office hours (traditional banking hours), while others, including payers, are available via phone. To do this effectively, employees will also need to maximize “off-hours,” and complete certain tasks while children are occupied or asleep.
Some initial ideas are presented here. Off-hour tasks can help employees prepare for and maximize phone activities during regular hours:
- Off-hour tasks
- Billing (clearing edits, etc.)
- Account history research in preparation for payer phone calls
- Drafting appeal letters (based on provided templates)
- Online claim status checks
- Regular-hour priorities
- payer phone calls and associated documentation
- Huddles and formal team meetings
Staff engagement and productivity
In a virtual environment, it is more important than ever to help keep staff engaged and effectively measure staff productivity. Quick reimbursement and policy questions between colleagues while investigating accounts or while on hold with a payer will now seem like large obstacles to the newly remote workers.
While necessary in the short term, these concepts are unlikely to change as more business office work transitions to remote environments. Many of Nordic’s clients as well as our internal employees have been working remotely for a long time, so we’ve picked up a few tips we can share:
- Many enterprise desktop application suites offer collaboration software, like Slack, Zoom, Skype, Teams, etc. for fluid, informal instant message exchanges outside of email and voicemails.
- Establish structured daily huddles to set priority on the day’s work and discuss daily issues and questions on processes and specific accounts.
- Enable video conferencing to reduce the sense of social isolation among team members.
- Utilize Epic’s User and Supervisor Scorecard dashboards for real-time productivity monitoring. Absent direct supervision, having strong productivity monitoring tools in Epic to monitor time in system, accounts worked, amounts recovered, etc. is crucial.
- Use VoIP software to monitor call volumes where possible
You can also leverage your EHR to monitor and manage productivity and monitor which members of your team may be fatigued or struggling and when a training intervention could be needed. We've compiled a few tips for you to leverage funcationality specific to your Epic or Cerner EHR.
Reporting and key metrics
When staff are not congregated in a physical, collaborative space that allows for immediate and informal communication, it becomes paramount for supervisors to monitor metrics and share daily, weekly, and monthly goals with the team to manage its progress.
Make sure your staff, whether using team or individual goals, understand how their productivity metrics are a critical leading indicator that directly influences the business office’s downstream process metrics (e.g., CFB, A/R over 90, denial days) and the organization’s overall performance metrics (cash!).
Tying positive trending productivity metrics to celebrations and acknowledgement of your staff is equally as important as tying negative trending productivity to performance improvement discussions. During this pandemic, it is important to help staff remain motivated and goal-oriented in the face of an uncertain financial outlook.
For example, some team-based weekly goals could result in the following celebratory, team-building recognitions such as:
- Scheduling a virtual “end-of-week happy hour” using Zoom, Skype, or Webex
- An employee-of-the-week award image that can rotate between your team members’ Microsoft Office avatars and is visible on each email they send and each online meeting they join
- Adding a “recognitions” message board component on the business office’s Epic Learning Dashboard
While disruptive in the short term, it is likely that a trend toward increased remote work for revenue cycle employees will remain after the effects of the pandemic start to stabilize. Building space and infrastructure are expensive, and organizations are realizing that while this may not have occurred on their terms, they can see significant cost savings, as well as staff retention and satisfaction as a result of more remote flexibility for employees. In addition, eliminating a daily commute can improve your staff’s well-being with personal time saved and a positive impact on the environment. The pandemic has pushed us to look back at the way we’ve done things and adapt, but it’s an opportunity, to look forward and leap.
If you have any questions about a virtual office, maintaining your revenue cycle, or any other health IT questions during the COVID-19 outbreak reach out to AskNordic@nordicwi.com to receive trusted advice at no cost.