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Proactively addressing revenue integrity in the era of COVID-19

Vasilios Nassiopoulos (vnassiopoulos@hayesmanagement.com) is Vice President of Platform Strategy and Innovation, Hayes in Wellesley, MA.

The COVID-19 pandemic will undoubtedly leave a permanent imprint on the healthcare landscape. The heightened role of technology, especially as it relates to data access and analytics, is one area that will leave a lasting mark as a differentiator for care and operational efficiency, as well as actionable response.

Amid the initial surge and ongoing impact of COVID-19 cases, healthcare organizations are relying on sound guidance and advanced systems to optimally care for patients. It is also more imperative than ever that they prioritize revenue integrity strategies. While analytics play a key role in helping monitor the progress of the disease and the global healthcare community’s efforts to contain it, it is also laying the groundwork for sound revenue integrity practices within a fluid and evolving crisis.

The revenue risks associated with the pandemic are expected to be substantial. Consequently, compliance and revenue integrity departments must be proactive in preparing for the inevitable scrutiny that lies ahead for COVID-19–related claims to ensure their organizations’ ongoing success and sustainability. Government monetary stimulus is helping, but hospitals must capitalize on all appropriate reimbursement opportunities and avoid the revenue cycle bottlenecks that can result from denied or delayed claims. They must also quickly and proactively identify and address compliance issues to avoid the potential for bottom-line losses down the road when auditors come knocking.

Ongoing oversight and readiness will require proper allocation of resources supported by the right infrastructures to overcome a fluid regulatory landscape and other challenges. Manual efforts to stay abreast of additions and changes to procedure and billing codes—along with evolving treatment regulations and reimbursement policies—will leave many organizations simply reacting to revenue risks, opening the door for revenue problems that can quickly spiral out of control; that’s why forward-thinking organizations are getting their revenue integrity house in order now.

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