An interesting phenomenon has been occurring within the HBI membership community. Since the beginning of the COVID-19 pandemic, revenue cycle leaders have been coming to HBI to ask questions such as “How are others being mindful of the fact that our patients are losing jobs and income?” This question only becomes more pervasive as unemployment filings in the U.S. have exceeded 35 million. Leaders note that their organizations are relying on payment plan arrangements to help their communities get by while still trying to maintain the cash flow necessary to continue treating COVID-19 and non-COVID-19 patients now and in the future. They wonder: “What are others doing? What am I not thinking of?” The answer is that we are really in this together—most organizations are taking very similar approaches to be more lenient and compassionate during these times.
HBI has been surveying its membership and the industry at large on which processes or policies have been altered and how since March and continues to (click here for survey results). These ongoing results mixed with regular conversations and discussions with leaders reveal six key responses that are being widely taken. In order of most prevalent:
- Allowing patients to enroll in new payment plan arrangements and extending existing payment plan arrangements. HBI survey data reveals that 36% of organizations increased payment plan repayment deadlines due to COVID-19. Nearly 11% are allowing extensions of 61 to 90 days, 10% are extending deadlines by 31 to 60 days, and 6% are only going up to 30 days. However, just over 5% provided extensions of 121 days or more. Providers have noted they are no longer being strict with minimum monthly payment thresholds and are instead open to accepting what patients can pay each month. Click here for scripting HBI developed related to coronavirus payment plan concerns. HBI has also surveyed organizations on the documentation required by patients in order to grant such options—for now, the largest portion of organizations (28%) are only asking for verbal statements from patients.
- Suspending legal action on past-due accounts. About 31% of organizations have done so due to COVID-19. Nearly 23% are suspending lawsuit filings, 17% are suspending garnishment of wages, 15% are suspending the filing of liens, 14% are suspending activity on pending liens, and 13% each are suspending activity on pending lawsuits as well as collection on existing garnishments.
- Adjusting financial assistance or charity care processes or requirements. About 19% of organizations have done so due to COVID-19. Some organizations have extended eligibility effective dates by 90 days, added an option for patients to indicate on financial assistance applications if they have been financially affected by COVID-19, and time frames for submission have also been extended.
- Suspending credit bureau reporting. Nearly 18% of organizations have done so due to COVID-19 and will halt this action until at least after the national emergency status and local stay-at-home orders are no longer in place.
- Adjusting out-of-pocket discounts. About 17% of organizations have done so due to COVID-19. For the most part, organizations are relying on the waived copays and cost-sharing from insurers currently in place, but extending that approach to self-pay patients receiving COVID-19 testing and treatment per the terms and conditions for receiving funding relief through the CARES Act. (Click here for an HBI roundup of recent COVID-19 regulations.) A few organizations have stated they would either not charge patients or provide them a deeper discount, while another noted relying on a combination of payment plans and discounts to help patients during this time.
- Increasing patient statement cycles. Nearly 14% of organizations have done so due to COVID-19. About 5% added two rounds of statements, 4% added one round, and 2% added three statements. However, 3% added five statements or more. Others noted that they would be adding 120 days to the statement cycle, suspend the referral of accounts to collection agencies, and suspend existing account activity among agencies. Others may be delaying referrals to early out agencies by at least 20 days, but still having them conduct an initial call to patients with a softer approach to help assess which patients may need assistance or are expressing hardship, notate accounts, and determine which accounts to hold from there.
Stay in touch with HBI. As organizations adapt to this rapidly evolving situation and also look to bounce back from the pandemic, HBI will continue its research and update our findings.
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