While there have been numerous discussions and looks into how the COVID-19 public health emergency is impacting hospitals and health care providers, very little has been said about how the billing companies who handled revenue cycle management for these individuals and entities are responding to this unprecedented situation. With surgical and lab volumes dropping almost across the board, and a patchwork of statewide stay-at-home orders making working in the office all but impossible, we wanted to reach out to some of the top billing firms in the nation to see how they are adapting and continuing to serve their clients.
Here are their responses. (Note, some answers have been edited lightly for clarity).
Question Guide: Click any of the following links to jump straight to the response.
- What actions are you taking during this time of change?
- How are you changing self-pay bill cycles?
- How are your employees handling the work-from-home model?
- How has the end of elective surgery affected your pathology groups?
- How has this affected your lab groups? Are they billing for COVID-19 testing?
- For pathology and lab what percentage decrease in volume are you seeing?
- What is your prediction as to when billing will return to “normal” again?
- What message do you have for your customers during this time?
What actions are you taking during this time of change?
Mike Summers: Vice President of Client Services, Change Healthcare (CHC):
- Numerous changes include working from home for nearly all employees and increased pushes for reduction of paper in all aspects of the cycle. We are holding daily calls with all CM’s, leadership, and operations. The changes in the market are coming at a feverish pace so over communication is paramount. We are also sending blasts out to clients, holding WebEx meetings, and working on weekly volume trends (among many other tasks).
Tom Scheanwald, President, APS Medical Billing:
- We have relied on remote or home workers for many years as we recruit billing talent from around the country. So, we already had the back bone in place to move more of our staff to work from home. We have to retain minimal staff in our offices and have provided for adequate spacing between those employees. Individual performance metrics were already in place and monitored throughout the day to ensure that the work is getting done. In the short term, I don’t believe that we will return to a workforce that is office based. We will need to continue to have employees work from home and rely on technologies that are available to enhance communication.
Lâle White, Chairman and CEO, XIFIN:
- All of our staff for outsourced billing, as well as nearly all of the billing staff of our customers doing in-house billing, are working remote. Since system automation and electronic transactions are optimized for our customers, staffing requirements are much lower and billers working from home do not have printing requirements and can perform all activities electronically and remotely. While we have very robust user specific productivity metrics to manage the billing processes, we have created even more granular reporting to support managers and executives managing remote employees as well as a focus on aging analyses to make sure any time gained by lower volumes is shifted to the collection of old AR. In addition, we are testing machine learning algorithms that show us which staff are most productive at specific accession types.
Corey Wilbeck, Vice President, Revenue Cycle Management Sales, TELCOR:
- TELCOR has a business continuity plan which covers a wide variety of situations and through this plan we have enacted our pandemic policy. As such, TELCOR has taken the necessary precautions to protect the health and safety of our customers, employees, and our community while maintaining a consistent level of service for our 2,600 customers across North America.
Joe Seale, Director of Pathology, MSN Pathology Services:
- MSN has a well-defined, rigorous, and proactive disaster recovery process. MSN has implemented these processes to support our employees working remotely to help maintain our clients’ income as much as their volume will support.
How are you changing self-pay bill cycles during this time?
- Some MSN clients have elected to delay self-pay bill cycles an additional 30, 60, or even 90 days. MSN can fully support this.
- No changes to self-pay billing cycles have been made during this time. Our customers continue to send statements to patients regularly and follow payer disposition when billing patients. If any customers choose to change their patient billing cycles during this time, TELCOR will work with them to make the necessary accommodations.
- Our customers make those decisions, and in some cases, they have added our texting features and portal access to enable greater patient convenience for communication and payment. I have not seen dunning cycle changes, but some labs have delayed collection efforts after a full dunning cycle.
- This is on done on a client by client basis, as is the strategies for collection agency files.
How are your employees handling the work-from-home model?
- Employees are doing remarkably well. We were already used to this situation from previous natural disasters (hurricanes and floods), so many already knew the drill.
- This is an area in which we excel. Our solution is a SaaS platform, which enables us to quickly deploy resources to any location. Because of our substantive reporting capabilities and enhanced remote communications, we have seen no loss of productivity, and in some cases, higher productivity. We have taken on additional services for clients who have had to reduce labor costs during this period and been able to take that on seamlessly for our customers. Interestingly, patient calls and portal use has increased. More patients at home with extra time I guess, but the handle rate has not missed a beat.
- With our business continuity plan in place, we followed the directives in that plan and transitioned to a telework model. TELCOR normally conducts business within our physical office, so with employees being remote, we are relying on collaboration tools such as WebEx and Microsoft Teams ® to remain efficient. Due to school closures, TELCOR has been flexible in allowing our remote workforce to work non-standard hours such as evenings and weekends. By doing so, we’ve been successful keeping productivity metrics unchanged.
- MSN employees have been incredibly resilient with these new processing changes. MSN can manage staff efficiently through business intelligence reporting whether they are working remotely or in-office. MSN employees act as part of an MSN family and are very dedicated to the success of their clients and that of MSN.
How has the end of elective surgery affected your pathology groups?
- Depending on the case mix of the practice, the impact has been significant. We have estimated that many practices accessioned cases are down 40 – 70%. They are still getting hospital patient cases such as cancers and resections, however, electives, derm and GI surgeries are significantly reduced. Most are considering the financial stimulus programs that the federal government has come out with.
- As with all medicine during this time, there is a decrease in volumes based in part on the postponement of elective surgeries.
- As expected, there has been a significant decrease in the number of samples coming in from pathology customers. However, this is a good time for many of our customers to focus on implementing the ability to work remotely, implement additional system features that promote productivity and to spend time providing additional training and education to their billing teams. Now may be a time to focus on those lower priority initiatives and to make overdue updates to documentation and other internal supporting materials.
- Pathology clients have seen the biggest decline.
- Many pathology groups are seeing massive decreases in volumes over the past few weeks (50%). Depending on the procedure mix and locality of the groups, some were impacted more than others.
How has this affected your lab groups? Are they billing for COVID-19 testing?
- Labs impacts are varied depending on the mix of volumes. Generally speaking, they are not being impacted to same degree as the pathologists. Yes, some are starting to bill for COVID, though this just started on a larger scale.
- Clinical labs are down in routine testing, but that is offset with COVID and Respiratory testing. We are seeing a net decline between 25-55% depending on how much COVID testing is done. This is consistent with Quest reporting a 40% decline.
- Some clinical or traditional laboratory customers have also seen a decrease in the number of samples coming in as patients are not going to their doctor as frequently or routinely for common visits, but other testing remains active based upon patient condition. We do have customers who are billing for COVID testing, both to payers and direct to their clients. Based on the published Medicare rates for these tests, if other payers follow suit, a significant reimbursement on COVID tests is forecasted.
- Independent labs and reference labs have seen dramatic decreases in volume. As certain hospital labs get approved to run the test, we will see some of this billing.
- Accepting some of the stimulus funds requires that they be used for CoVid-19 testing and related patient care. In addition, cost sharing by the patient is being further defined by the federal government, states and insurers. In the meantime, we are billing insurers for the CoVid tests and any related tests.
For pathology and lab what percentage decrease in volume are you seeing?
- The volumes for hospital-based groups has just begun to decrease depending on their geographic location, and we should know the full extent of the impact in the next week or two.
- Overall, across our customers we have seen a decrease of anywhere from 30%-40% on average for clinical testing. For pathology testing, that decrease is within the 45%-60% range. However, we have seen molecular laboratories where their testing remains constant and other laboratories that are expanding with the SARS-CoV-2 testing.
- We are seeing about a 45-50% decline in pathology and about 20-60% in labs overall (based on their COVID strategy) at this time, although the slippage seems to be plateauing.
- It is varying widely. Some groups are only seeing a 10% decrease in volumes where other groups are seeing up to 60% decreases. Weekly flash reporting is pointing to a 25% decrease in the past few weeks across all business. Interestingly we are now witnessing pockets of elective procedures reopen late last week.
What is your prediction as to when billing will return to “normal” again?
- Our core billing functions are running as normal right now across our Path/Lab operations centers. Our new “normal” is evolving weekly and our ability to leverage legacy Change Health technologies is helping. I envision our product on the back end even more efficient and effective.
- Billing has not really been disrupted for us, so the only issue is the volume decline and when that will normalize. The one exception of a bit of a slow-down is with some payors on electronic claims that require a review, redeterminations requests or appeals that require manual review. This is the area we are watching as payors continue to have issues addressing claims matters that require manual intervention. We expect that after the quarantine restrictions business will come back quickly with a 60-90 lag for cash to ramp back up.
- There is no doubt that this pandemic will redefine what “normal” is for everybody. From our perspective our at-home workforce will probably remain there, at least for the foreseeable future. New technologies in the lab will be redefined. For some insurers, they have struggled at times adjusting to an at home work force. They will need to be flexible and adapt in order to conduct business. New technologies that enhance communication will be in demand. And so on. It will be an evolution of sorts in our industry. Timing and velocity of the recovery is the million-dollar question.
- The pandemic has impacted every community in our country, changing lives and processes in many cases for the long-term. When each community gets to the other side of the curve and businesses open, which they will, we will all be working together to establish a “new normal” and this includes the area of testing and billing for that testing. Testing will always be required to provide optimal patient care and some of the federal financial assistance is going to assist with recovery. Laboratories can use this as an opportunity to position themselves for improved profitability when the new normal is established.
- MSN believes this is a question better answered by the response of the US economy as it in turn responds to the impact of the Covid-19 virus and the country’s compliance to social change during this time. It will depend on how hard each geographic location of the country is impacted as to when hospitals will be able to return to normal volumes, even if the US economy as a whole is ramping up faster.
What message do you have for your customers during this time?
- The key is to weather the storm, be flexible and keep expenses and other costs in check.
- MSN has continued to communicate directly with customers during this time regarding the continued processing by MSN staff whether in-office or remote. MSN is very strong and has the capacity to handle this “change” better than most companies in this industry based on many factors. Those factors include but are not limited to MSN being a privately held and very stable company, MSN using the very best technology available in our industry, and MSN having long standing and diverse partnerships with supporting companies to allow the continued operations for clients.
- TELCOR is here for our customers. Our business continuity plan has been successfully executed allowing employees to work remotely, although as an essential service our office is still open and staffed. Safety to our employees and providing service to our customers is our critical mission. Additionally, we are positioned to respond to unique customer needs during this time, e.g. extra help with their billing or another example is our POC Business Unit responded quickly to ensure a new device that can perform SARS-CoV-2 testing has connectivity with our customers systems.
- Our customers have provided us with feedback that they are thrilled at how quickly they were able to convert to remote billing without missing a beat. I think the message we have been giving our in-house billing customers is that we are able and prepared to help them with needed cost savings by providing them with billing services at a more economical rate than they are achieving internally or with off shore services if they are using a service that is currently unable to perform. We just want them to know that our operations have not been impaired and that we are their extended resource as needed. Mostly we believe that this incident is a great example of why the entire industry needs to adopt an aggressive cloud and data strategy.
- I am extremely proud of CHC’s ability to flex with the situation and move our workforce so quickly to home (done within 1 week across all 3 centers). Our ability to stay agile throughout the pandemic has minimized disruptions to the billing cycle. Additionally, by leveraging experience and technologies across our company we have been able to quickly adapt during this time. Our client management team looks forward to seeing our clients face to face after this dissipates.