Revenue Cycle Management for the Pandemic


Past RBMA President Christie James, American College of Radiology Commission on Economics Chair Greg Nicola, M.D., and Revenue Cycle Coding Strategies President Melody Mulaik discuss the radiology revenue cycle management challenges and solutions of the pandemic.

COVID-19 has left no corner of radiology untouched with impacts reaching wide and deep throughout the industry. But, the effect has not been the same for every practice and clinical environment, so the strategies groups use to re-claim a solid footing must be different.

Earlier this month, Diagnostic Imaging examined revenue cycle management in the pandemic for both academic and community practice environments. In a webinar, sponsored by independent healthcare technology company Change Healthcare, industry experts touched on reimbursement and payer challenges, employer obstacles, long-term post-pandemic investments, and lessons from the front lines that can help radiologists continue to navigate the shifting practice landscape.

Together, industry leaders Melody Mulaik, president of Revenue Cycle Coding Strategies, Christie James, immediate past president of the Radiology Business Management Association and senior manager of radiology revenue cycle optimization at Massachusetts General Hospital, and Greg Nicola, M.D., chair of American College of Radiology’s Commission on Economics and executive leader of Hackensack Radiology Group, discussed some of the most significant issues facing the industry and what their groups have individually experienced.

“It is often said that innovation occurs in war time, and, arguably, this pandemic is kind of a war time environment that has forced some different things,” Mulaik said. “We need to think about how our world has changed and what COVID-19 has done to us as a disruptor.”

One of the biggest changes, Nicola said, is the industry-wide pivot toward virtual waiting rooms that allow patients to wait for appointments in their cars. It’s a move, he said, that has been a long time coming and that should have been here sooner.

“It’s a shame none of us really implemented this in a robust fashion prior to COVID,” he said. “But, now we don’t have patients waiting in waiting rooms, potentially passing infections to each other. That’s potential office space we can use for exam rooms or more imaging modalities.”

Not only does it save time by asking patients to pre-register, he said, but it also eliminates the need for patients to pass by staff or other patients they do not need to see. Cutting down on staff registration responsibilities can also free those employees up for other initiatives.

From a billing and coding perspective, James said, the switch to at-home work opened up opportunities for greater productivity and collaboration. Staff can easily share and keep track of documents and dashboards that are critical to revenue cycle management. They also stay in close touch with regular meetings, she said.

“We’re not meeting every day, but we have touch points,” she said. “Our senior leadership staff has been extremely transparent with everything that we’ve been working on for the past four or five months.”

However, she added, it is difficult to foster new relationships or build trust when you do not work face-to-face on a daily basis.

“We can put fires out well over virtual meetings, but I think building camaraderie, teamwork, and trust is extremely hard that way,” James explained. “So, I do see some long-term problems with continuing to function in this way.”

Nicola also addressed how more remote reading among providers has addressed a long-standing problem in the industry – radiologist burnout. By working from home to avoid viral exposure, providers in his practice have found a new beneficial work-life balance, he said.

“We have changed our shifts enough that we’ve gotten such good feedback from radiologists,” he said. “They’re really appreciative of having some more home time with their kids and of being able to have more flexible rotations where they get a couple outpatient rotations a week and can start working at their own pace instead of always getting phone calls about patient care.”

In addition, James said, her office has allowed for greater flexibility for providers and staff to work during off-hours.

“We’ve tried to be very flexible,” she said, “allowing people to work later in the day or earlier in the morning so that they can take over with parental responsibilities as needed.”

Lastly, Nicola pointed out practices that applied for relief funds through the federal government should start paying attention to how those loans will impact them as the year comes to a close. It is still unclear what the effect will be on accounting responsibilities.

“Honestly, I’m glad we took it. I think it helped us weather a severe storm here,” he said. “But, there are still a lot of unanswered questions on what that money did for us and what the consequences of taking it are going to be. I don’t think those questions will be answered until near the end of the year.”

To potentially avoid any problems, he suggested individual practices begin identifying specifically how that money was used so they can account for it correctly on their tax returns for the coming year.

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