PHS Team Shares Insights about Trends in 2021

The PHS Physician Team shares some key issues they noted in 2020 and trends they anticipate in the New Year

Even as the first phases of vaccines are being given in the U.S., public health officials say it will take months for everyone to receive both doses and develop immunity to COVID-19. That means healthcare organizations will continue to be stressed by the pandemic for some time to come.

The following are key issues noted by the Paramount Health Solutions physician team in 2020 relative to CDI/DRGV and revenue cycle operations, and what we anticipate in the year to come.

Hospitals will continue to operate in new ways to respond to the pandemic

During the first waves of the pandemic, hospitals developed workaround methods to cope with the challenges they were facing. This included furloughing CDI nurses or sending them back to work on the floors. Coding staff began working remotely, while some hospitals entered into contract arrangements for coding services. Chief medical officers who typically advise on coding and CDI put their administrative duties on the back burner during the pandemic as they justifiably focused on patient care.

These mitigations have continued and are necessary. But they also come with risks, such as breakdowns in communication, loss of collaboration and increased errors and omissions in coding.

Payor denials are increasing

Last spring during the early outbreaks of COVID-19 payors weren’t denying coding and medical necessity as much, but starting in June and July, denials became more frequent and have continued.

Financial distress continues for hospitals

As reported in Becker’s Healthcare, rural hospital closures hit a record high in 2019 which followed a steady increase over the previous three years. A study by the American Hospital Association found that the median hospital margin overall was 3.5% pre-pandemic, and that at least half of U.S. hospitals will be in the red at the end of 2020. The AHA projected in October that U.S. hospitals would lose more than $323 billion in 2020.

We anticipate further winding down, closures and bankruptcies in 2021. Funding by the Federal PPP program helped for a while, but that money has run out and hospitals are faced with fewer elective procedures, higher expenses tied to the pandemic, and reimbursement issues.

New Coding Guidelines

CMS issued new guidelines related to COVID-19 last April and again in October. A new set of guidelines starts Jan. 1, which include 21 new ICD-10 procedure codes for COVID-19 vaccines and therapeutics.

According to a survey conducted in the fall by the Healthcare Financial Management Association’s Pulse Survey Program, and reported by RevCycle Intelligence, unpredictable work/claim volumes, followed by confusion over codes and requirements for COVID-19-related claims, were the top issues impacting revenue cycle operations at U.S. hospitals and health systems.

How Hospitals Can Respond

These are troubling trends whiplashing the healthcare industry. We offer these tips to help healthcare organizations bolster their revenues:

  1. Focus on correctly following coding and billing guidelines from CMS and the CDC, while paying special attention to new codes related to COVID-19 care.
  2. Identify the root causes of errors to help physicians and staff avoid them going forward.
  3. Technology can play a role, especially systems that utilize artificial intelligence to monitor processes, flag problems, and perform targeted audits.
  4. Consider partnering with a physician-led CDI/DRGV consulting company like Paramount Health Solutions that can help identify issues, educate personnel, and initiate changes that can ensure smooth revenue cycles and accurate reimbursements.