When the first wave of the COVID-19 pandemic hit hospitals in March 2020, many hospitals canceled elective procedures and furloughed revenue cycle staff as patient volumes dropped significantly. However, as hospitals restarted these procedures, the backlog of patients that had deferred their initial appointments caused a sudden increase in revenue cycle work volumes and staffing needs. This was exacerbated by the need for more manual review of accounts due to the new workflows and evolving billing requirements for COVID-19 claims, resulting in additional work for staff and lower productivity outputs.

Read the full paper by Cory Gu.

While the pandemic is expected to subside this year with the rollout of newly developed vaccines, many revenue cycle leaders are realizing the need to be more prepared and flexible when faced with future work interruptions and changes. A workforce productivity management system, which analyzes the number of staff needed to complete the work and the corresponding performance outputs of those staff, will be critical. Revenue cycle leaders should implement three strategies to establish and sustain an effective workforce productivity program:

Regularly assess both work and production volumes for staffing requirements.

Analyzing work and production volumes such as total registrations, inbound/outbound calls, claims coded, and follow-up workqueue volumes is central to identify how many full-time employees (FTEs) are needed. These volumes fluctuate throughout the year and should be reviewed on a recurring basis.

Most revenue cycle department staff use workqueues as their primary workdrivers. Leaders should work with IT to create weekly reports that provide both the inflow volumes for assigned workqueues and the ending backlog volumes.

Leaders should then use existing organizational or industry productivity benchmarks to calculate the corresponding FTE hours required to work these populations. The inflow FTE hours represent the minimum staffing the department needs to sustain operations, while the backlog FTE hours represent the overtime or additional one-time support needed to complete all accounts.

Ensure there is a direct line of sight into the team’s priorities and work.

At any given moment, leadership should know what their staff are working on, especially now that so many are working in remote settings. One way to facilitate this is by developing individual responsibility assignment matrices that highlight the standard priorities that need to be addressed each day of the week, unless otherwise instructed. For example, Medicare collections staff could be assigned to prioritize working high-dollar Medicare denials on Monday. Likewise, the focus on Tuesday could be on working aged accounts.

Additionally, while many organizations may monitor daily productivity, leaders should also review and monitor hourly productivity reporting. Leaders will find that while some staff are achieving daily standards, there may be significant unexplained gaps in productivity that, when addressed, could lead to even higher production outputs.

Establish “operational levers” that can be pulled to address short-term staffing deficiencies.

Maintaining the right number of staff for revenue cycle departments can be a challenge due to higher staff turnover and difficulty finding quality applicants. Certain operational levers can be “pulled” in the event of significant staffing deficiencies to mitigate the potential effects of an increase in backlogs:

  • Extend initial follow-up dates for “no-response” claims. Denials and/or underpayments still should be triggered through exception-based follow-up processes.
  • Set minimum deferral date ranges to allow for more touches on unique accounts. This can be paired with “push” projects, in maximizing accounts receivable (A/R) coverage by assigning accounts that have not been previously touched and setting the minimum deferral time to forty-five days.
  • Adjust automated low-balance write-off thresholds to a higher amount.
  • Adjust underpayment variance logic to a higher percentage or dollar threshold of the expected reimbursement.
  • Evaluate one-time outsourcing populations and thresholds (if A/R vendors are established).
  • Transition any credit balance staff temporarily to assist with less-complex A/R populations.

For example, the initial follow-up touch for no-response claims can be extended with minimal risk, if there are exception-based workflows to triage denials or underpayments. This allows for the follow-up teams to focus on the at-risk accounts. Additionally, leaders can leverage existing A/R vendors to assist with one-time outsourcing of populations that may require higher effort with lower yields.

By incorporating these three strategies into the organization’s management system, revenue cycle leaders can evolve to manage staffing and performance agilely, even in the face of evolving healthcare challenges.