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COVID-19: Maintaining Momentum During Volume Recessions

  • Director of Anatomic Pathology Development

Pathology practices and laboratories across the country have begun to feel the financial impact of COVID-19. With most states placing a moratorium on elective surgeries until late April, or strongly recommending it, diagnostics providers are seeing anywhere from a 30-60% drop in their outreach volumes (see our Lab Volume Index for a more detailed breakdown). With the deterioration of margins in the path/lab space, we’re all under pressure to assess every opportunity to generate revenue in the midst of one of the most significant and rapid economic declines in history. 

As healthcare providers, we often find ourselves in a relatively stable environment. Whether it’s economics or world politics, healthcare is generally isolated from recession-related events. So when most practices anticipated restrictions on elective procedures,  proactive discussions should have taken place to discuss the need to align business needs around the potential volume impact, and RCM should have been among the top three on the list for review.

RCM teams are the kingpins of revenue generation. When volume takes a hit, it is the team’s responsibility to seek out every opportunity to clean up queues and outstanding AR, and build systematic logic to more effectively streamline processes. One day the healthcare engine will turn back on, and when it does, your RCM provider better be prepared.

We have to keep in mind that pathology isn’t the only segment struggling right now. Every surgeon, anesthesiologist, radiologist, gastroenterologist, etc., that performs elective surgeries shares our pain. Once restrictions are lifted, every segment of this industry will go into hyperdrive, and pathology and molecular testing providers should brace for a spike in volume once the COVID-19 pandemic has subsided.

So while practices plan how they will manage the weeks ahead, let us not overlook the importance of how RCM can provide the most significant vulnerability to revenue stabilization.  If a bolus of volume is received and billing companies aren’t prepared or don’t have the workforce to support the spike in volume, horrendous backlogs will plague them. In that case, it’s inevitable they won’t get collections in the door nearly fast enough for their clients to feel any relief. While these potential challenges won’t necessarily be evident now, in a matter of weeks or months, their performance will be put to the test.

During this time, it would be advantageous to ask your billing provider how it has responded to this pandemic, how its social distancing protocols work, and what the game plan is when business returns to normal and volumes begin to recover (rapidly). Below are several key areas you should take into consideration:

Work from Home

  1. How has work from home been implemented? Was there IT support, technology, and equipment to allow for quick and secure deployment for staff required to stay home?
  2. How much of your workflow is manual, and can it be performed remotely? If not, how will this impact the ability to maintain the timeliness of your billing? Keep in mind that payors have adopted timely filing windows of 90-180 days.
  3. How is the security of PHI and system access for employees who traditionally do not work remotely addressed? Is activity monitored for potential PHI violations?

As a California based company, XIFIN was on the frontline of facilitating a work-from-home solution for our employees. While our business is considered essential, many of our staff have children that are now out of school, elderly parents requiring care, or conditions of their own that would put them at risk if they were exposed to COVID-19. Our cloud-based platform, underlying technologies, and robust team of IT resources allowed us to facilitate a remote plan for more than 80% of XIFIN’s workforce in less than a week. You can read more about what we learned from the experience and see a remote work environment checklist in our recent blog post, Implementing a Remote Working Environment in Response to COVID-19? A Checklist to Get You Started.

Productivity Management

  1. How is productivity managed for on-site and remote employees to ensure teams are still focused on your business?
  2. What processes are in place to ensure your business will not realize a large backlog of work while employees juggle the management of their work and personal responsibilities during this time?

RCM providers who cannot deploy remote capabilities to their billing staff will realize a sharp decrease in productivity due to reduced staffing. By using dynamic productivity, financial, and workflow reporting packages along with a robust web conferencing platform, XIFIN’s staff is armed with a robust suite of tools that will allow them to continue hitting their targets, ensuring little to no productivity impact to our customers.

A/R Clean Up

The additional bandwidth billing teams will realize during times of lower volumes can’t be overlooked. Exception/error queues should be reviewed in-depth by billing teams and management. Projects previously on the back burner should be readdressed. Ineffective workflows requiring manual intervention should be revisited and automated, if possible. These efforts could help drive additional revenue and keep an otherwise trying time a little more manageable.

Patient Call Center

Manage call wait times and possible patient complaints. This may be the most difficult department to staff appropriately during this time, and potentially one of the largest vulnerabilities for companies who cannot deploy an effective work-from-home model.


To learn more about the latest testing, testing supply needs, and payor billing requirements related to COVID- 19, visit our COVID-19 Laboratory Resource Center.
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Published by XIFIN
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