Maintaining Collections During a Pandemic

In late January the Coronavirus reached the United States, radically changing the trajectory of 2020 in ways we won’t soon forget. No area has experienced more disruption and uncertainty than healthcare. From shortages of personal protective equipment and ventilators to reductions in elective procedures, from expectations of additional strain on emergency services to unclear revenue outcomes with questions about collections during a pandemic, the concerns for healthcare providers right now seem endless.

Hospitals can expect to feel financial pressure from this pandemic on several fronts. First, according to Rhett Brown, Managing Director, Research Analyst at Lazard Asset Management, in an article in The Bond Buyer, patients will choose to forgo profitable elective procedures this year, and the resulting excess capacity may or may not be replaced with treatments for patients with Coronavirus. And those treatments will end up costing hospitals additional revenue. Health Leaders predicts that nearly all hospitals would lose an average of $2,800 per Covid-19 patient case if reimbursement rates are not increased from the currently proposed rate.

We are hearing these same concerns directly from our clients. One shared that they are already experiencing a 30-percent reduction in their daily census, and if it continues, they predict a 50-percent drop in revenue.

Costs for supplies are also on the rise due to shortages in both the normal supply chain as well as the Strategic National Stockpile. New York Governor Andrew Como shared that masks that normally cost around 85-cents each were now costing $7 when they could be found. He, like others, have called for the government to nationalize the medical supply chain to help hospitals afford much-needed supplies. Hospitals will also see a rise in personnel costs as additional cases of Coronavirus are diagnosed that require a higher level of care.

Price gougers are also appearing in the critical drug and medical supplies markets, trying to cash in on the pandemic. In recent weeks, investment bankers and others have pressed healthcare companies to consider ways that they can profit from the crisis. If allowed, that profit will come in the form of higher costs passed on to hospitals and patients.

Compounding these rising costs are stories of mass unemployment spreading across America faster than the disease. Prior to the passing of the CARES Act, Treasury Secretary Steven T. Mnuchin had claimed that the unemployment rate could reach as high as 20-percent if lawmakers did not take action. While these are eye-opening numbers, the flip side is that if this awful scenario comes to be, 80-percent of the US workforce will remain employed without a major income disruption.

With the challenges the Coronavirus is creating, the last thing healthcare providers have time to worry about is their revenue stream. But in these uncertain times it’s never been more important. With significant reductions in incoming revenue, some hospitals – especially those in rural and smaller community settings – could be forced to close their doors. Alan Morgan of the National Rural Health Association recently told Kaiser Health News that if short-term cash isn’t addressed, we’re going to see hundreds of rural hospitals close before this crisis ends.

Considering the ramifications of these factors, it’s imperative that hospitals continue to collect any and all revenue possible during the Coronavirus pandemic, including self-pay balances, but the key is to do it in the most patient-friendly way possible.

First and foremost, empathy is paramount to collecting success and sensitivity to those affected by Coronavirus is essential. The unknown can cause emotions to run high, and there’s no place for anything less than kind, understanding words and actions. When on a call, and a patient says that they are experiencing financial hardship due to the Coronavirus, it is best to thank them for their time, mention any financial assistance options they may have available, apologize and end the call.

Here are a few additional steps that we recommend your collections partners take to help minimize the impact health issues will have on your patients during the Coronavirus pandemic:

  • Flag Accounts – Add a notation to accounts that are suffering financially due to the Coronavirus in both your system and your collections partner(s) system. An example of this is Epic users adding a Billing Indicator to track the accounts and ensure that collection activities cease until the pandemic has subsided.
  • Credit Reporting – Have your collections partner(s) temporarily stop reporting to the credit bureaus. With so many other issues occurring surrounding this pandemic, it is not the right time to affect an individual’s credit. This will also ensure that Coronavirus-related charges do not accidentally get reported. We do not know what will happen with these charges in the future.
  • Legal Action/Garnishments – Have your collections partner(s) pause all legal action and wage garnishments. As with credit reporting, this is simply not the right time to pursue these types of actions.
  • Insurance Check – Reviewing, identifying and verifying that insurance was correctly applied to your patient’s accounts is another step you and your collections partners can take to help maximize your revenue. Some accounts may be payable but were not correctly covered by the insurance company. Having your collections partners help identify missing insurance and follow up on these accounts could lead to the insurance company paying, which is a major patient satisfier.
  • Explore All Avenues of Additional Reimbursement – Look for opportunities to apply for Cobra with patients who may have recently lost employment. Additionally, backdated Medicaid or disability will become a greater revenue source for hospitals.
  • Financial Assistance – More patients will qualify for financial assistance, so working to qualify these patients as efficiently as possible will be extremely beneficial. This includes Medicare patients who will also qualify for Medicare Bad Debt. 

We have to remember that while there will be some patients who are unable to pay their bills, many will still have the means to pay. These are the patients you will want your collections partners to focus on communicating with during these times. Additionally, it is important to keep your inbound communication options strong, making it easier for patients to reach out to you with any questions or payments.

Though the nation is in turmoil, it is important to ensure that letters and responses required by law are still sent to patients regarding disputes, payment plans or receipts in a timely manner. Stay on top of any changes on a national and state level to remain in compliance, even when dealing with Coronavirus fallout.

Here in Wisconsin, Governor Tony Evers enacted a “Safer at Home” order, which closes any non-essential business. Hospitals from across the state have shared with us why it is important for collection agencies to remain operational during the Coronavirus pandemic. One such letter said,

“With respect to the COVID-19 response, [collections] are a critical function to [our facility] and our patients.  Patients during this trying time will need assistance planning their financial future, and [our facility] needs to continue to utilize [collection] services to maintain adequate cashflow.” 

The truth is, the Coronavirus is going to impact hospitals for the foreseeable future. There are several topics you will want to discuss with your collections partner/agency now to ensure they are prepared to support you during the pandemic.

  • Remote Workforce – Validate that they have made provisions for their staff – especially collectors – to be able to work from home. Stay-at-home directives will quickly shut down call center-based collections, making it harder, if not impossible, for them to continue operations.
  • Technical Infrastructure – If your partner/agency says that they are prepared to have their collectors work from home, ask for information on their technical infrastructure. A remote workforce has drastically different needs than office-based staff, and their system may not be able to handle this change.
  • Essential Business Status – While many jobs can and will be done from home, there are responsibilities (printing, incoming/outgoing mail, payroll, etc.) that will have to be handled from the office. If your collections partner(s)/agency does not have “Essential Business” status, any shelter in place orders will stop them from working on-location.
  • Remote Training – Collections can be a high turnover industry, and with the uncertainty caused by the Coronavirus, there will be a need to add and replace collectors. Make sure your partner/agency has the ability to hire and onboard new employees remotely. If not, you may see a decrease in revenue due to a dwindling workforce.

Nobody knows exactly how the Coronavirus will impact our country in the long or short term, but your survival may depend on ensuring a consistent collections revenue stream. Please take the time to review your current partners and agencies to safeguard your employees and patients during these uncertain times.

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