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Five Revenue Cycle Management Resolutions for 2021

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January 7, 2021

A clean slate. A fresh start. A new beginning. Whatever phrase you use, it’s that time of the year when everyone makes resolutions to eat better, be better, and live better. Similarly, for healthcare organizations, it’s a time to recalibrate and reset—to pivot and rethink old strategies that are no longer effective. It’s also a time to prepare for what lies ahead—new regulations, new medical codes, new potential denials, and continued financial uncertainty during COVID-19.

As with any resolution, it’s about setting sensible goals and then staying the course to achieve them.

Five Revenue Cycle Resolutions to Consider

Our organization will validate office visit evaluation and management (E/M) codes to ensure revenue integrity.

New E/M guidelines that take effect January 1, 2021 represent a significant departure from the ‘way things have always been done.’ More specifically, these guidelines require providers to assign E/M codes based on time or medical-decision making. Although the history and exam are important for medical necessity purposes, they don’t drive actual code assignment. Without pre-bill validation, organizations could miss out on revenue or be on the hook for overpayments. Now is the time to educate physicians, clinicians, coders, and CDI specialists, update templates, and develop documentation aids and internal coding guidelines. Also, audit, audit, audit. Don’t wait until the end of the first quarter to discover easily preventable errors.

Our organization will prioritize telehealth coding, billing accuracy.

This should have been a priority throughout 2020, and it will be equally as important in 2021. Telehealth coding and billing continues to evolve, and without close oversight, organizations could make mistakes that could cost them in both the short- and long-term. For example, throughout the public health emergency (PHE), CMS added 144 services to its list of telehealth-approved services, making it easier to close care gaps and improve access. In December, the agency announced it would continue to pay for 59 of these telehealth services beyond the end of the PHE and make nine telehealth services permanent. It will be paramount for revenue cycle staff to monitor these and other changes—including variable payer coverage—moving forward. Equally as important is the ability to capture informed consent for telehealth services—a critical component of compliant billing.

Our organization will stay abreast of COVID-19-related coding, billing changes.

This should have also been at the top of the priority list in 2020. However, 2021 gives organizations the opportunity to renew their dedication to coding and billing accuracy during a time of intense regulatory change. Most recently, CMS updated its FAQs on COVID-19 billing as well as its list of CPT codes for COVID-19 vaccines and monoclonal antibodies. In addition, six new COVID-19-related ICD-10-CM codes take effect January 1, 2021. Best practice is to appoint someone in the revenue cycle who can monitor these changes and raise awareness among key stakeholders as necessary. Sounding the alarms as quickly as possible will be key.

Our organization will engage consumers to achieve documentation integrity.

In 2021, transparency is the name of the game. And it’s not just about price transparency. April 5, 2021 is when information blocking enforcement begins per the Final Interoperability Rule released by the Office of the National Coordinator for Health IT. The rule, which is part of the 21st Century Cures Act, prohibits information blocking. It’s important for revenue cycle staff to educate physicians and clinicians about how to document with patients in mind. It’s also important to educate patients about this new mandate so they can work collaboratively with the organization to improve documentation integrity.

Our organization will strive for a clinically-integrated revenue cycle.

Long gone are the days when medical coding and CDI can operate successfully in silos. In 2021, the two disciplines need to work in tandem and with a united front to prevent denials and ensure revenue integrity. They also need to have open and honest conversations about the systemic problems that plague the organization. It’s through these conversations that effective and lasting change can emerge.

Remember: Identifying a resolution is only one part of the equation. Following through with it is equally as important and oftentimes far more difficult. Organizations that set realistic and clear goals—and revaluate those goals commensurate with regulatory changes— will be successful in 2021 and beyond.

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