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Revenue cycle considerations during and beyond COVID-19

COVID-19 brings with it serious financial concerns to physician practices across the nation.

According to a survey released by the Medical Group Management Association (MGMA) on April 14, 97% of medical practices have experienced a negative financial impact and report, on average, a 55% decrease in revenue and 60% decrease in patient volume since the beginning of the crisis.

These challenges are accentuated at specialty surgical practices where elective surgeries were canceled and constitute most of their revenue.

This drastic drop in revenue and patient volume forces medical practices to furlough or lay off staff. According to the survey, as of April 8, 48% of practices have had to furlough staff and 22% had let some of their employees go. It is projected that these numbers will increase to 60% and 36% respectively by May 8.

The federal government is attempting to support medical practices with programs. Those include:

  • The Public Health and Social Services Emergency Fund to reimburse eligible healthcare providers for healthcare-related expenses or lost revenue linked to COVID-19
  • CMS’s Advance Payment Program (APP) which offers accelerated cash flow up to 100% of the physician’s Medicare payment amount based on a three-month lookback period
  • The Employee Retention Credit which allows eligible providers to claim a refundable payroll tax credit for 50% of qualified wages paid to employees after March 12 and before Jan. 1, 2021 (with a maximum credit of $5,000 per employee)
  • The opportunity to defer paying the employer portion of certain payroll taxes through Dec. 31
  • The Small Business Administration Paycheck Protection Program to help employers retain employees at their current pay

Much of the financial and operational consequences of COVID-19 are out of our control and it is uncertain when we will get back normal. The following are four areas where revenue cycle leaders can help organizations stay afloat and prepare for a possible second wave.


One of the silver linings of this pandemic is the rapid adoption of telehealth tools such as FollowMyHealth®, which helps healthcare providers deliver patient care virtually. Telehealth has not only helped minimize COVID-19 exposure to patients seeking care unrelated to the coronavirus, it also provided a different source of revenue for physicians who were not using these platforms or were not allowed to bill for them. Billing requirements have been eased with the Coronavirus Preparedness and Response Supplemental Appropriations Act.

When it comes to coding and leveraging every dollar available to bill, practices need to clearly understand all the requirements listed under telehealth services. They include virtual check-ins, online digital evaluation and management, online assessments, remote monitoring and  telephone calls. It is also crucial to follow all guidelines to code COVID-19-related services. Both MGMA and the American Medical Association (AMA) have great resources to help organizations navigate the different scenarios. Check them out: AMA and MGMA.

Accounts receivable management

Although it is financially challenging to keep the business office running during this time, it is key that practices work to maintain a streamlined revenue cycle that focuses on patient collections, tight denial management and follow-up automation.

Employer layoffs will bring a shift in most practices’ payer mix. This highlights the importance of checking eligibility for every patient. It also highlights the need to have automated processes to facilitate the collection of outstanding balances such as online and mobile payment capabilities, automated credit card deductions for payment plans, estimation tools, and automated collection letters and phone calls.

As is expected every time practices start using new diagnoses and procedure codes, we should anticipate an influx of denials due to coding errors. Leverage your denial management tool to detect these denials as quickly as possible. The goal should be to implement processes to enhance documentation and to configure coding rules within your practice management system to capture and automatically correct possible errors before the claims are billed out.

Managing schedule volumes

Once stay-at-home orders are lifted and it is safe to reschedule patients who have been postponing care, it is essential that practices leverage technology to prioritize urgent visits that align with patient needs and the practice’s goals.

The first-come/first-served approach will lead to no-shows taking over potential spots for patients. Consider tools such as Opargo, which use predictive analytics to highlight high-need visits, reduce no-shows and cancellations, and increase resource utilization.

Preparing for a second wave

With potential of a second COVID-19 wave in the fall, organizations should implement an infrastructure to support a revenue cycle system that can be managed remotely.

Evaluating the following components to formulate strategies for the future can minimize practice disruption:

  • Can your employees securely and reliably access your revenue cycle tools?
  • Can you securely and efficiently assign work to your team members?
  • Can you automate current paper-based processes?
  • Do you have documented policies and procedures for all revenue cycle activities?
  • Can you easily track staff productivity and leverage tools to promote communication and collaboration?
  • Do you have access to analytics tools to trend key performance indicators?
  • Could you leverage a partnership with a third-party vendor with already-established processes to support high-performing outcomes?

These are unprecedented times and many practices are managing unimageable emotional, operational and financial challenges. Once this crisis passes, those nimble enough to adapt to new opportunities will be in a better position to ride future waves.

If you need assistance assessing and implementing the infrastructure to future-proof your revenue, Allscripts revenue cycle management experts can work with your organization.

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