3 Tactics to Rebuild Revenue in a Pandemic

The healthcare industry has dramatically changed due to the coronavirus pandemic. Revenue streams have been disrupted by postponed procedures and patient populations turned upside down by record-breaking job losses. No one knows the future ramifications of payers waiving cost-sharing for coronavirus-related care, or if there will be another surge in cases. “Business as usual” doesn’t apply to healthcare in a world with COVID-19. The new healthcare will be dominated by patients paying out of pocket, and new tactics are needed to adapt the hospital revenue cycle to the new normal.

AN UNEXPECTED BATTLE

At the time of this writing in Summer 2020, the healthcare industry is locked in battle with COVID-19. Hospital revenue cycles have seen long term damage due to non-essential procedures being cancelled to free up resources vital to combatting the pandemic. Now, the world makes strides towards flattening the curve, developing vaccines, containing the spread and reopening sensibly, all efforts towards the same goal: life after COVID-19.

It’s to this post-COVID world that we must look when we re-examine the transactional relationship between provider and patient. The patient population will look drastically different coming out of the crisis than going in: the unprecedented 40 million COVID related unemployment claims through the first week of June 2020 speak to the millions of Americans who have lost jobs—and health insurance—to coronavirus. Some will retain benefits through COBRA, Medicaid, or ACA Marketplaces, and millions will remain uncovered. As non-essential procedures become available again, many will struggle to afford them. Many will skip care. And many will see worse outcomes because of it.

Our post-COVID reconstruction will be an out-of-pocket era, and hospital revenue cycles must adapt and employ new tactics to rebuild, recover, and survive.

A NEW PATIENT POPULATION: “BETWEEN INSURANCE”

The coronavirus has created a unique cohort of patients who are without health coverage at various stages of the pandemic. “Uninsured,” and all the connotations that come with that designation, is an imperfect fit for this group. These patients are adrift between plans, losing benefits from one company but only a new hire away from regaining employer sponsored coverage. As the economy recovers and jobs open up, many of these patients will find themselves comfortably covered by employer plans again. But timing is uncertain.

Uncertainty defines this patient cohort, those who are “Between Insurance.” These are patients who are accustomed to their healthcare being covered to some degree, and any experience with out-of-pocket responsibility came in the form of a deductible, copay, or coinsurance. These are patients who have historically had a high propensity to pay—they have had no reason not to.

A Kaiser Family Foundation (KFF) study published on May 13, 2020, examined the options available to an estimated 26.8 million Between Insurance patients affected by coronavirus-related job loss.

The KFF study reinforces the uncertainty plaguing those who are Between Insurance. Your patients are asking: “What if I don’t find a job before my uninsurance benefits expire? What happens if I can’t afford the marketplace premiums?” Many of your patients will have to decide if they can delay their care until they get coverage again. Many Between Insurance patients will not have the luxury of waiting and will come to you as self-pay patients.

Your revenue cycle will begin to see an unprecedented influx of Between Insurance patients and others paying out of pocket. Many providers and hospitals depend on revenue from commercially insured patients to make up for losses incurred when treating Medicare and Medicaid patients.3 In the wake of coronavirus-related job loss, millions of patients will move from that commercially insured pool to the pool of Between Insurance patients, which makes it all the more important to guarantee collection. Mistakes in the collection process could result in surprise bills and uncompensated care without a system to ensure payment.

3 TACTICS TO REBUILD REVENUE AFTER COVID-19

TACTIC 1: PREVENT FINANCIAL COUNSELOR BOTTLENECK

Who: Patient Access Staff

What: Alleviate the burden on Financial Counselors and speed up the selfpay collection process. Challenge To Solve: Typically, patients without insurance are sent directly to the Financial Counselor. Increasing numbers of Between Insurance patients could overwhelm your financial counselor and bottleneck your collections process.

How:

Step 1: Create Accurate Price Quotes

Choose a transactional platform that gives an immediate, accurate price quote for patient services included in the episode of care. Be sure the technology you choose has the capability to immediately process the most common types of payment, including credit card, debit card, FSA, HSA, HRA, cash, or check.

Step 2: Establish a Prepaid Self-Pay Policy

Before sending self-pay or Between Insurance patients to the Financial Counselor, have your Patient Access Staff generate a price for the episode of care and attempt to collect payment in full on that price from patients paying out of pocket for their service. Save your Financial Counselors for patients needing payment plans or charity care. This payment simplification will likely also improve your patient satisfaction.

Step 3: Train Staff to Identify Prepay Candidates

You can further reduce bad debt and protect your collections by extending this policy to any patient paying out of pocket, including:

• Uninsured and Between Insurance

• Patients with an unmet deductible

• Patients whose insurance has denied coverage for their procedure

Once you have enabled more of your patient access staff to collect payment, you have the option to collect at multiple stages of the patient journey.

TACTIC 2: COLLECT PAYMENT EARLY IN THE PATIENT JOURNEY

Who: Prior authorization, Schedulers, Pre-registration, Registration

What: Collect from prepay candidates at the earliest touchpoint in the patient journey. This allows patients to understand their financial responsibility, budget for care, and prepare to pay in full prior to service.

Why: Upfront payments facilitate a better revenue cycle by receiving a predetermined upfront payment versus unknown payments in the future. Additionally, clear upfront payments will drive a better customer experience and contribute to higher patient satisfaction while alleviating workload for patient access staff closer to the point of service. Every prepayment collected over the phone by a scheduler is a collection that doesn’t need to be taken at registration or chased by billing.

How:

Option 1: Help Patients Complete their Own Purchase

If the transactional platform you choose has the capability, you may be able to send patients their price quotes through secure email or text message and have them complete their purchase through the software itself. This can be done at any stage of the patient journey. Just ensure that the quote includes the services in the patient’s episode of care and instruct them to pay online then bring proof of purchase to their appointment.

Before Appointment, at Prior-authorization or Scheduling:
“It looks like you’re paying out of pocket for this procedure. The total cost is going to be [$XX]. I’ll send your price quote to you through a secure website, and you can go ahead and pay online so you’re all paid up and you won’t have to worry about billing.”

At Appointment/Registration:
“It looks like you’re paying out of pocket for this procedure. The total cost will be [$XX]. I can go ahead and process that for you right here, or if you’d prefer, I can send you this price quote through a secure website and you can complete the purchase on your smartphone. That way, you’re all paid up and you won’t have to worry about billing.”

Option 2: Assist Patients With Their Purchase

As long as your transactional platform can process payments via credit card, debit card, or health account cards, your patient access staff can complete a proxy purchase over the phone with the patient. If a patient needs to pay with cash or check, make sure your platform allows you to collect payment at registration with the patient present.

Before Appointment, Prior-authorization or Scheduling:
“It looks like you’re paying out of pocket for this procedure. The total cost is going to be [$XX]. I can go ahead and process that payment for you right now if you’d like to use a credit or debit card. That way you’re all paid up and you won’t have to worry about billing.”

At Appointment/Registration:
“It looks like you’re paying out of pocket for this procedure. The total cost will be [$XX]. I can go ahead and process that for you right here if you’d like. That way, you’re all paid up and you won’t have to worry about billing.”

TACTIC 3: CONSUMERIZE YOUR TOP 5 SERVICE LINES

Who: CFO, Revenue Cycle Directors, Service Line Directors

What: Make your top 5 service lines available for prepayment to launch your self-pay / Between Insurance collection strategy as soon as possible.

Why: You can capture more cash-pay patients sooner by making the services most frequently purchased out-of-pocket available first. This simplifies and expedites implementation. You can introduce additional service lines over time while capturing prepayment for the bulk of out-of-pocket procedures.

How:

Step 1: Identify Your Top Out-of-Pocket Service Lines Based on Volume

This commonly includes diagnostic services and imaging, but can also include frequently ordered services that could be deemed not medically necessary by insurance. Common examples include:

• Imaging

• General Surgery

• GI

• Bariatrics

• Labs

Step 2: Train Your Staff to Offer Prepayment for Those Services

If you are developing a Prepaid Self-Pay Strategy from Tactic 1, incorporate a phased strategy for when each service line will be added to the prepayable offerings.

Your policy may simply state the five service lines available for prepayment at launch. Given the uncertainty surrounding the resurgence of COVID-19, it may make sense to watch how pandemic control progresses to see when the next phase makes sense, in the event another ban on non-essential services is levied.

Consider, however, that the more services you have available for prepayment, the more revenue you will be able to capture from Between Insurance patients and other self-pay patients when the procedure bans are lifted.

CERTAINTY IN AN UNCERTAIN TIME

The coronavirus pandemic is an exercise in resilience and flexibility. This is forcing us to think about new ways of enhancing our revenue cycle management programs. A prepayment strategy offers enhanced certainty in an uncertain time. You can always count on revenue that has already been collected.

By adopting a strategy of prepayment along the patient journey, you also give this sense of certainty to your out-of-pocket patients. Many patients, especially those who are uninsured, high deductible, or between insurance, are having to make hard choices:

“Do I get my gallbladder out, or do I fix the air conditioner?”

“Can I wait another year to get my knee replacement?”

When you give these patients an accurate price upfront, you give them the ability to make informed decisions about their healthcare. They can budget for the services they need, which is crucial for patients living on stimulus checks or riding out a furlough. We don’t yet know how the coronavirus will affect the rest of 2020 and beyond, but with an upfront prepayment strategy, you and your patients can take back a measure of control, and enhance your Revenue Cycle Management program for all patients.