COVID-19 Challenges the Revenue Cycle to Shift to Remote Work


By Richard L. Childs, FHFMA, VP RCM, Floyd Medical Center

The COVID-19 Pandemic has changed the workforce in healthcare in a variety of ways. Some will be short term and others are here for good. The clinical settings changes are all about not spreading the virus and heavy use of Personal Protective Equipment (PPE). It is not just the clinical staff donning and doffing PPE. Those that encounter the patient population like registration, housekeeping, and cafeteria staff, to name a few. Glass partitions between the registrar and the patient is a new normal and probably here to stay. To minimize exposure in the non-clinical side of health care brought on new challenges for office staff. One of our goals was not to have to furlough or lay off any of our associates.

We were able to get 65% of our back-office revenue cycle teams into a remote work environment in less than two weeks.

In densely staffed offices and cubical where primarily business functions occur, the inability to socially distance brought a concept that was not widespread in healthcare – Remote working. Offices had to look at options in a short period of time to reduce the on-site workforce to keep socially distanced in the workplace while at the same time, not sacrificing productivity, which drives cash flow. 

Medical Record coders have had a long history of working remotely. This was one of, if not the first area that started working remotely in the healthcare arena. Why can’t that model work in other areas that are traditionally computer-based and all the work is basically if not 100% done online? We quickly found out that it can work just as well and, in some cases, even better!

Hospital back offices quickly worked with their Information Systems & Technology (IS&T) departments to acquire the necessary equipment that would allow their staff to work remotely. Depending on the different roles that people were in, drove what equipment needs they had. Investments in laptop devices, extra monitors, keyboards, telephony devices for those that were call center based. One requirement of your associates was internet access; without that, you could not work remotely.

In my facility, we quickly obtained the equipment and started moving the staff that could do their entire jobs remotely, to home. We were able to get 65% of our back-office revenue cycle teams into a remote work environment in less than two weeks. That entailed scheduling, pre-service registration, referrals, billing, follow-up, customer service, revenue integrity, and denials management teams. Those that either could not work remotely, newer staff that needed training, or those that the job required them to be on-site were still coming into the office. To keep them socially distanced, those in the office had to spread out from their traditional spaces. 

There were other changes for those associates still coming in, temperature checks, and having to mask up when not at a socially distanced workspace or office. Break rooms had to be reconfigured to allow six-plus feet of separation during lunch breaks. All in all, a very different work environment. 

There were other factors that came into play during the pandemic that effected the remote workforce. Many had children that were also required to be at home, schools shut down early, and daycare operations closed. These obstacles required further change. Many roles had to function in traditional working hours like the customer service teams and those tied to when physician offices were open. Others like billing and follow-up were not tied so much to standard working hours.  Those teams were able to work non-traditional hours and still get the work completed in a timely manner. This was extremely important as revenue streams were heavily decreased when elective procedures and emergency room volumes dropped way below normal. We had associates working early morning and late evening hours to get the work completed. This has worked well and not put a strain on the work effort. If anything, it was more conducive to the needs of our associates. It allowed them to keep working and take care of their families.  

What have we learned and where do we go from here?  First, a remote workforce does work for the back-office revenue cycle functions. It is more flexible for the associates, which improves associate satisfaction. Allowing associates to work remotely has also broadened our ability to recruit associates from further away. We are a more rural area and the ability to widen that scope has helped to recruit those more complicated, and specialized positions. A remote workforce also allows for a reduction in office space needs. That may be less office rental space needed or may allow for growth in clinical space that had previously been used for office work. This translates into increased revenue and/or decreased expenses. Increased productivity is a reality in the remote workspace. Associates who are happy perform better. It also reduces absenteeism for minor illnesses.

Next steps? Maintain a remote workforce throughout the pandemic. What about after the pandemic? Maintain and create a hybrid model. Associates can alternate weeks in and out of the office. This can help within-office training and socialization with your teams. There can be isolation and the feeling of being left out when you are at home all the time. We must connect with our associates. We are using and will be expanding on a Wednesday change over. That way, those alternating weeks have time in the office each week and are able to connect with others. It also allows the associate to take care of things they may need to do in the office. Some of that connectivity can be done online. Developing an online “coffee break” allows associates to connect with each other on a social level that they are missing when strictly working remotely.

The pandemic has proven a new effective work model for the back-office revenue cycle processes.

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