April 27, 2020 | Net Health

4 min read

Revenue Recovery Strategies in the COVID-19 Era

By Tannus Quatre, PT, MBA, Vice President, Net Health

There’s a common saying in rehab therapy that is especially relevant today:  cash is a fact, and AR is an opinion.  However, in the COVID-19 era, knowing the status of both AR and cash is critical to survival.

Recently we presented a webinar on Revenue Recovery Strategies with our revenue cycle management (RCM) expert Matt Zabolotny, MBA.  He and Irene Elston, another revenue cycle management (RCM) veteran with more than 20 years’ experience, outlined several real-world cash management tips that can help any rehab therapy practice weather the COVID-19 storm. View the webinar.

With that being said, it is still important for them to explore the expansion of service offerings and to beef up their AR recovery process for the long term.

What we don’t want to happen is for someone to read this after the waiver expires and to come back to us saying we told them they could do telehealth because legislation changed, when it’s really a temporary fix at this point:

Staggering Statistics

The last 30 days have certainly taken their toll on rehab therapy practices.  Most have seen a 60 to 75% decrease in patient volume.  Some have shut down for the interim.  Some of our colleagues have had to close. 

There is at least a partial silver lining; we also see legislation loosening, enabling providers to explore promising new models, including Medicare Part-B In-Home Care and Telehealth, though that legislation could short-term.  Indeed, the rapid evolution of the profession could be exciting and promising…if we can all get to the other side of the curve.

And with the right strategies, we can.  Because of the decrease in utilization, it’s more imperative than ever that rehab therapists are paid for every service provided.  Achieving that goal requires four critical steps.

  1. Solidify your current operations
  2. Ensure consistent authorization management
  3. Automate eligibility verification
  4. Manage denied claims

1.Getting Operations in Order

Solidifying operations includes equipping your organization with the right people for the right roles and making sure they have the training and resources to meet your needs. For example, you may require short-term staffing to take care of basic operations to free up your more skilled personnel to work where they will have the most impact.

You’ll also need to track key performance metrics.  The key here is not to look at your UCR or gross.  Get a good grip on net charges, specifically your cash (a) to net charges (b) ratio a/b = collections.  A good target is 90%.

2. Managing Authorizations

One of the more common reasons for unpaid claims is payers who charge that a claim was unauthorized.  Diligently tracking those claims is key.  Your Electronic Medical Record (EMR) system can help.  An equally important tactic is to assign an individual who can focus a significant portion of their time to tracking authorizations.  Authorization management is a critical step for reimbursement.  Look for someone who can dedicate the majority of their time to this effort to ensure the process is well-managed.

3. Automating Eligibility

Don’t be afraid to invest in automated tools or use a clearinghouse or other company to help better automate eligibility.  Ensure whatever system you use offers exception reporting.  Even if there’s an additional fee for the service, it will pay for itself.  One of the key benefits of automating eligibility is that it allows you to quickly catch changes in coverage and ensure you are billing the right company. Other benefits include:

  • Reduce labor hours
  • Minimize chance of errors due to manual verification (which also helps reduce hours)
  • Use resources and tools that increase staff efficiency, freeing up time for other important tasks.

Managing Denied Claims

Here’s a disturbing fact:  according to CMS 40% of denied claims are written off and not reworked. Of course, the other reality is that the reasons given for denial are often vague.  However, without that knowledge, it’s hard to correct problems in the future.  

If your denial rates are more than 20%, it’s time to do all you can to get them down to 5 to 10%.  

To nail down the process, consider authorization and eligibility, as well as the percent of denied claims affected by those two issues.  The time and steps you take will be worth the effort. For example, documenting workflows will help correct problems causing denials.  

Solutions for Today

At Net Health, we talk to rehab therapists daily.  We know the current environment is troubling. To help, we recently introduced a risk-free Revenue Recovery Program with no upfront costs.  Learn more.

Hear the full webinar and all the great questions and responses received.   The next few months will continue to be challenging for our profession. But we will survive.  Go forth and conquer and turn to Net Health for assistance and support.

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