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Dealing with COVID-19 induced Revenue Cycle Management fluctuations

By Ilyana Rosenberg

The COVID19 crisis has drastically impacted patient care and how services are delivered in the outpatient setting. Although ambulatory care has begun to rebound, the previous few months were challenged by significantly reduced volumes, furloughs, and layoffs. As restrictions begin to ease, health care organizations across the country are implementing measures to comply with new treatment regulations and increased patient volumes. Although the rise in census is a desperate sigh of relief for most of the industry, the shortage of medical coders and fluctuating emergency department volumes have made it difficult for organizations to deploy the appropriate staff-to-volume ratios. These COVID-19 stressors highlight a systemic challenge with the manual process of clinical coding today and shed light on the importance of fully automated coding solutions.

Decline in Patient Volumes
The Coronavirus forced organizations around the globe to suddenly suspend elective testing and procedures during its rapid, and highly transmissible outbreak. A study conducted by Strata Decision Technology (Strata) reveals a decrease of 54.5% in the number of patients who sought care in a hospital setting when comparing a two - week period between March and April 2019 versus March and April 2020. The analysis included 228 hospitals, encompassing 51 health care delivery systems that span 40 states.

FAIR Health reports that hospitals in the Northeast realized a 26% decline in average per-facility revenues when compared to the same reporting period in 2019. FAIR Health’s second survey: Illuminating the Impact of Covid-19 on Hospitals and Health Systems: A Comparative Study of Revenue and Utilization uncovers that the third week of March witnessed thousands of new Covid-19 cases in certain parts of the United States, most commonly in the Northeast. This surge in positive Coronavirus cases directly impacted the number of emergency department encounters, per day. According to the June 12, 2020 weekly report from the Centers for Disease Control and Prevention (CDC), the number of ED visits decreased 42% per week during the early pandemic period of March 29-April 25, 2020.

The CDC further defines the decrease in emergency department visits by age group and region:

The decrease in patient volumes has created significant cash flow crises for organizations across the country. These unprecedented times are creating economic ripple effects as hospitals are struggling to maintain pre-COVID-19 staffing levels and have been forced to reduce schedules, layoff, furlough and terminate team members to stay afloat.

Ease of Restrictions
Restrictions are gradually being lifted on elective testing and procedures. Hospitals are permitted to diagnose and treat non-emergent conditions, provided they have sufficient personal protective equipment (PPE) for front line medical workers that could be exposed to COVID-19.
Most states have implemented a phased approach to opening elective procedures in an attempt to eliminate risk of exposure. Other common state-to-to-state requirements include:
  • Organizations have to obtain sufficient PPE without affecting local government resources.
  • Implementation of policies/procedure to support appropriate cleaning, signage, and social distancing.
  • Ability to provide masks to customers entering the health care facility.
Although many states have begun providing services for elective procedures, others are still in the process of considering conditions and developing their re-opening strategies.

Census Spike
It is anticipated that the reinstatement of elective procedures will produce a mass increase in patient volumes. Millions of patients are awaiting care or the rescheduling of non-emergent procedures that were previously delayed in order to comply with state-specific COVID-19 restrictions. As states re-open elective procedures, facilities will likely be challenged by the surge in patient volumes while also maintaining capacity and social distancing requirements for COVID-19 patients.

Coding Backlog
Although no comprehensive survey data is available, it is likely that backlog and COVID specific coding challenges are arising as a result of the spike and fluctuation. While there is no solution in sight yet for pandemic induced spikes and their effect on the front line, we know that we can rely on the scale-flexibility and consistency of new automated coding technology to help with the back-office consequences.

Fully Automated Coding
Autonomous coding is a fully automatic artificial intelligence solution that requires no human intervention. It understands unstructured physician language and can explain the rationale behind each code assigned. Autonomous coding solutions provide significant value to healthcare and revenue cycle management organizations. A fully automated coding solution offers:
  • Accurate medical coding - High accuracy rates - over 98%.
  • Reduced days in accounts receivable - A fully automated coding process increases efficiency and accelerates payment cycles.
  • Optimized audit process - Detailed audit trails provide full rationale behind the code assignment. Audit reports automatically generate thereby providing on-demand chart review capabilities.
  • Continuous compliance - Audits trails offer a full coding rationale and serve as a resource for validation and appeals, while also reducing compliance risk.
  • Reduced denial rates - High accuracy rates minimize the volume of denials and rejections previously associated with coding errors.
  • Reduction in operational costs - A fully autonomous coding engine requires no human intervention, therefore requiring fewer coders and coding educators.
When applied to a scenario such as the one we are experiencing with COVID-19, an automated coding solution can:
  • Reduce denials related to COVID specific diagnosis coding.
  • Eliminate backlog and effortlessly handle volume fluctuations.
  • Reduce discharged not final coded (DNFC) accounts.
  • Increase speed to revenue.

The COVID pandemic has created significant challenges for health care organizations around the world. The fluctuation in volumes, and subsequent furloughs, terminations and layoffs has made it difficult for revenue cycle leaders to meet key performance indicators such as productivity, quality and expected turnaround times. Autonomous coding offers a seamless, cost-effective solution for reducing backlog, improving quality scores and increasing speed to revenue.

About Nym Health
Nym Health, an AI medical coding software provider raises the bar with its breakthrough, autonomous coding platform. Nym’s Clinical Language Understanding (CLU) coding solution enables autonomously processed medical records with exceptional quality. The NYM CLU coding engine provides fully transparent medical coding through revolutionary clinical language technology. The company aspires to streamline healthcare processes through new ways of processing clinical language. Processing at speeds of zero to over hundreds of charts per second, Nym's technology promises cost savings in coding operations and denial management.

For inquiries about partnering with Nym please contact us.

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