Financial health is essential to ensure that healthcare organizations can effectively serve individuals and communities. Natural disasters, cyberattacks, power outages, infectious disease outbreaks, and other emergencies can threaten the critical flow of revenue, putting patient care, clinician satisfaction, and the long-term sustainability of hospitals and health systems at risk. Healthcare providers lost as much as $1 billion per day from disruptions caused by the Change Healthcare cyberattack. Business continuity planning for the healthcare revenue cycle is a valuable strategy for protecting revenue flow and keeping your operations running smoothly.
The 3 phases of revenue cycle management
Revenue cycle management encompasses all administrative and financial processes to collect payment for healthcare services delivered. These processes can be broadly categorized into three phases:
- Front-end: Capturing patient demographics and insurance information, scheduling appointments, and pre-admission and pre-service authorization.
- Middle-end: Ensuring accurate coding and capturing of charges for services rendered.
- Back-end: Sending claims to payers, managing denials, collecting payments, and analyzing revenue cycle performance.
Examining healthcare business continuity through real-world scenarios
Developing a well-defined business continuity plan for each revenue cycle phase can help safeguard financial health by outlining alternative workflows and communication channels in case of disruptions. Consider how a robust business continuity plan can aid a healthcare organization in weakening the impacts of the following front, middle, and back-end emergency scenarios.
Scenario #1: The in-person registration system goes down due to a power outage.
Business continuity plan: Medical receptionists will use a paper-based backup system to capture patient information and schedule appointments. Once the electronic system is restored, appointments will be confirmed via phone calls.
Scenario #2: A surge in patient calls overwhelms the call center during flu season.
Business continuity plan: Staff will mobilize an overflow queue and implement a call-back system to manage wait times effectively.
Scenario #3: The EHR is unavailable due to a cyberattack.
Business continuity plan: Coders will follow procedures for manually documenting services and assigning temporary codes. Once the EHR is restored, temporary codes will be reconciled with official medical codes.
Scenario #4: A staffing shortage disrupts the medical record review process.
Business continuity plan: Available staff will prioritize urgent cases and allocate additional resources to ensure timely coding completion.
Scenario #5: A power outage disrupts the revenue cycle management system during peak claim submission times.
Business continuity plan: A backlog process is in place to capture and submit claims once the system is restored. Additionally, the health system has procedures for manual claim scrubbing to identify potential errors before submission.
Scenario #6: An internet outage disrupts electronic claim submissions.
Business continuity plan: Claims will be sent via alternative methods such as mail or secure file transfer. The healthcare system’s submission channels are diversified to help minimize reliance on a single vendor.
Scenario #7: A backlog of denied claims accumulates due to staffing shortages or disruptions in payer system integration.
Business continuity plan: The hospital will activate a prioritization strategy for claim review and resubmission, focusing on high-value claims. Clear payer communication protocols will help with identifying and resolving integration issues that may arise from third-party vendor cyberattacks.
Scenario #8: A natural disaster disrupts phone lines and postal services, hindering patient billing efforts.
Business continuity plan: Alternative communication methods, such as email and text messages, will be used to reach patients and collect outstanding balances.
A business continuity plan is a must-have for healthcare organizations
A comprehensive healthcare business continuity plan isn't just a good idea; it's a critical investment for patient care and financial well-being. Proactively preparing for care interruption and creating an agile revenue cycle can minimize revenue loss, ensure efficient claims processing, and retain patient trust even in unforeseen circumstances. With all the demands of running a hospital or health system, the time and effort required to create, and continuously improve, a business continuity plan that meets enterprise-wide needs can be daunting. A strategic partner with revenue cycle experience can bring lessons learned and best practices to help leaders develop and execute a future-proof business continuity plan while addressing potential challenges, such as costs, workforce capacity, maintenance and updates, and technical issues.
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