As essential service workers, healthcare providers are exempt from mandated work-from-home (WFH) directives. However, organizations are doing their part to flatten the curve and shift employees not involved in direct patient care to a remote model. For many, this means transitioning the revenue cycle—traditionally a brick-and-mortar operation—to a WFH setting.
While a shift to remote labor to offset costs has been a future vision for many high-performing organizations, the sweeping changes related to the COVID-19 response have resulted in strategies that would normally take years to implement being condensed to just weeks. Many leaders were not afforded the luxury of evaluating and instituting robust implementation plans to ensure the continuity of operations; however, this does not mean that operations must languish throughout the balance of the current crisis. In fact, the ability of the revenue cycle to continue operating efficiently is even more critical at a time when organizations are facing tremendous financial implications. And while there is still much uncertainty about the timeline and lasting impact of the pandemic, revenue cycle leaders must be nimble, learn from those organizations that have already implemented robust remote teams, and align operations for a potential sustained WFH period while looking ahead and developing strategies for the future.
Ensuring Success Today
Establish a Baseline WFH Infrastructure
Revenue cycle professionals must have fully functioning workstations with the necessary tools and technology available to effectively carry out their duties in a WFH setting. While a fully matured WFH infrastructure is ideal, the following components, at a minimum, must be in place today to ensure that operational capacity is not unnecessarily bottlenecked:
- VPN or remote accessto ensure PHI is not being transmitted over nonsecure home networks
- Astable, high-speed internet connection to effectively utilize EHRs and other commonly used tools that require sufficient connectivity
- Reliable telephony, preferably a solution that utilizes Voice over Internet Protocol (VoIP)
Promote Professionalism
Transitioning to a WFH environment will be a dramatic change for many revenue cycle employees. It will be critically important for managers to employ the same standards that are expected in an office setting.
- Establish consistent work hours and timekeeping requirements, and make them clear to staff. Provide reasonable flexibilityto allow staff to accommodate child-care requirements and other unexpected tasks created by the COVID-19 pandemic.
- Reinforce productivity and quality standards,and clearly communicate the expectations and accountability process for decreased performance.
Reinforce HIPAA Standards
The Department of Health and Human Services’ guidance concerning HIPAA and COVID-19 states that covered entities must continue to implement “reasonable safeguards” to protect patient information against intentional or unintentional impermissible uses and disclosures. The key takeaway for revenue cycle leaders is that the security of PHI must continue to remain a top priority, even in unprecedented times.
- Whenever possible, staff should maintain a dedicated office space in their homes and use privacy screens on their equipment.
- They should also be vigilant about locking their computer when they leave their office space and not discuss patient information with others present.
- Printing at home should be prohibited unless necessary and only allowable when the physical security of PHI can be verified.
In a typical WFH transition, organizations may validate the security of the remote employees’ workspace during an in-home IT setup; the current COVID-19 situation does not allow for this degree of thoroughness. At a minimum, redistribute and reinforce HIPAA policies and training materials to make sure staff understand the ongoing importance of protecting patient privacy.
Emphasize Communication and Collaboration
A significant challenge in managing a WFH workforce is keeping employees connected, engaged, and informed, so it is important to promote communication and collaboration in a WFH setting.
- Institute daily huddles.
- Have meaningful, daily, one-to-one interactions between managers and staff.
- Keep standing department-wide and other relevant meetings on the calendar.
- Develop a “daily digest” for goals and expectations.
- Provide multiple channels for communication (e.g., meetings conducted via Microsoft Teams, with notes and action items placed in a specific OneNote notebook).
Further, an unfamiliar environment may cause employees to feel isolated and stuck in a repetitive cycle. Prioritize employee engagement and find ways to have fun. Encourage virtual coffee breaks, “lunch and learns,” and video conferencing to maintain face-to-face interactions for regular communication.
Prepare Mitigation Strategies
Realistically, not all staff will be able to effectively operate from home due to a variety of reasons:
- Insufficient work environment (e.g., limited internet bandwidth, HIPAA compliance issues)
- Productivity challenges
- Paper-based processes (e.g., superbill posting, cashiering, scanning)
Organizations must be prepared for this reality, as it is likely that some staff may need to remain in the traditional office setting, thereby requiring measures to ensure a safe working environment (e.g., six feet between workstations). Alternatively, the push to a WFH strategy will have many administrators reevaluating the benefit of partnering with outsourced vendors that can be held accountable to high performance standards, despite the challenging time we are facing.
Preparing for the Future
Although working remotely has been on the rise for some time, the COVID-19 pandemic has unexpectedly accelerated the trend, and organizations will soon be contemplating whether a remote revenue cycle workforce can be their “new normal.” Now is the time for leaders to start laying the groundwork for what happens next; but where do we start? While every situation will be unique, there are some foundational questions that all leaders must consider with regard to maintaining a remote workforce, and this decision should not be made hastily.
While a baseline WFH infrastructure should suffice in the near term, consider the following for long-term success:
- Do you have defined processes for all revenue cycle activities?
- Are your technology solutions (EHR, laptops with cameras, etc.) appropriately configured for WFH?
- Do you have automated work drivers and robust productivity reporting in place?
- What is the cost of the brick-and-mortar office space? Is it leased or owned? Can it be repurposed?
- Does a virtual workforce present other cost savings (e.g., subsidized transportation, refreshments in the kitchen)?
- Are key revenue cycle metrics (A/R days, denial rates, bad debt as percentage of charges, etc.) trending in a positive direction compared to the pre-WFH period?
- What is the appetite of staff to remain in a WFH environment? Are there performance-based incentives that would effectively encourage increased productivity?
Without a mature infrastructure, organizations will be challenged to maintain a high-performing operation. However, assuming the appropriate components are in place to support the workforce, additional considerations apply:
Evaluating the environment now to formulate strategies for the future will ensure you are not caught flat-footed as the pandemic subsides. ECG is prepared to partner with your organization to assess and implement the ideal future state for your revenue cycle operations.
ECG continues to monitor our country’s response to the COVID-19 pandemic. Visit our COVID-10 thought leadership page regularly for trusted advice on how healthcare leaders and providers can weather this crisis.
Published April 20, 2020