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By: Winona Thomas BS HCS

According to Kaiser Health News, there has been a spike in retroactive denials for emergency department care and more patients are being caught in the middle of possibly becoming responsible for unresolved hospital bills.

Healthcare providers along with healthcare payers are finding challenges with keeping up with the evolving government guidelines for correct claim submissions of COVID-19 billing procedures. Challenges such as unnecessary claim denials, underpayment of claim payments or payment delays, and retroactive claim denials may pay tribute to increased volumes of patient billing.

In an article written in the Healthcare Financial Management Association (HFMA), Revenue Cycle leaders provide 4 tips to keep ahead of denials amid the pandemic.

  • Pinpoint the most at-risk areas – Identify areas where providers are most likely to have difficulties keeping track of varying payer requirements introduced a new level of intricacy to claim processing.
  • Strengthen team communications – As the workforce transitioned to a remote environment due to the pandemic, for health systems, that meant remote revenue cycle processes had not been fine-tuned across functions, presenting challenges for areas such as customer service and claim processing.
  • Proactively manage relationships with payers – An organization’s ability to identify changes to payer rules around COVID-19 and telehealth claims, in real time, and keep staff informed on the variances in billing rules by payer is essential to denials prevention.
  • Increase payment flexibility for patients – Health systems ramped up patient payment options — from self-service options to payment plan offerings – to ease consumers’ financial fears ex

One of the key components for healthcare providers is to be proactive with the implementation of new revenue cycle processes and procedures to facilitate improved payment and denial management strategies with healthcare payers and the consumer population.

Winona L. Thomas, BS HCS is an Account Specialist and Writer at MedCycle Solutions, which provides Revenue Cycle Management, Credentialing, Outsourced Coding, and Consulting Services to a number of healthcare providers in a variety of specialties. To find out more information about MedCycle Solutions services, please visit www.MedCycleSolutions.com.