Optimizing Revenue in a Challenging Environment

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    Optimizing Revenue in a Challenging Environment

    The severe impact of COVID-19 is being felt throughout all sectors and placing an unexpected, unplanned strain on county budgets and revenue. NACo’s Comprehensive Analysis of COVID-19’s Impact on County Finances and Implications for the U.S. Economy reports that counties anticipate a $202 billion impact to budgets through FY 2021, with $114 billion of that total being lost county-generated revenue. This unprecedented situation is further exacerbated by requirements to maintain a balanced budget and a prohibition on deficit spending.

    County health and human services providers and local health departments face other unique challenges that negatively impact their cashflow and operating revenue. For example, varying or non-existent insurance coverage makes it difficult and sometimes impossible for human services providers to be reimbursed for services provided to constituents. Additionally, the commonly-used sliding fee structure in public health can cause local health departments to fall behind on billing and struggle with lower collection rates. Staffing shortages at a time of increased demand for services presents another challenge not easily solved because adding FTEs, or even part-time resources, is often not a feasible option.

    Furthermore, counties are facing financial losses tied to a reduction in services provided during the COVID-19 pandemic, as well as additional expenditures for items such as personal protective equipment and workforce support.

    Some first steps in stabilizing revenue include:

    • Gaining patient confidence in new processes, such as telehealth
    • Rebuilding clinical capacity
    • Leveraging relaxed federal restrictions on service provisioning, such as phone calls vs. face-to-face
    • Positioning to take advantage of federal funding and grants emerging monthly, even one-time offerings

    While seemingly riddled with challenges in a COVID-impacted arena, there are other significant steps counties can take to manage and optimize revenue and budgets.

    Adjustments to billing processes and operations can help maximize reimbursements, capture lost revenue and even identify new potential revenue sources. Instead of writing off or not billing for services because it’s too complicated or time consuming, counties can leverage operational strategies and automation tools to identify and correct longstanding inefficiencies.

    With budgets facing more scrutiny and strain than ever, counties need a game plan. Not sure where to begin? Check out these three basic steps to optimize your budget, maximize your potential revenue and accelerate cashflow in 2021.

    1) Dive into claims data

    Data analytics can unearth stuck or undiscovered revenue. Key performance indicators (KPIs) provide visibility and an in-depth understanding of bottlenecks in the billing process. Once those barriers are identified, the focus can quickly shift to ensuring timely payment for services delivered.

    2) Dig into denials

    Research has shown that up to 90% of denied claims are preventable and that understanding the root causes is essential to denial prevention. Do you know your claims denial rate? It represents the percentage of claims denied by payers during a given period, which quantifies the effectiveness of your revenue cycle management process. If your denial rate exceeds 10%, appropriate steps need to be taken to ensure you can reduce and/or recover denied claims. Looking at your top three denial reasons can help you make the adjustments that will have the most impact. A 5% or below denial rate is achievable and indicates a healthy cash flow.

    3) Leverage technology

    Do you have the correct billing codes in your system? Are some services too complicated to bill for, causing write-offs? Leveraging technology throughout your billing process can help your operation become more efficient. Through automation, agencies can bill for all services, speed up the claims process and decrease the number of denied claims. Quality claims scrubbing, eligibility verification and pre-configured billing profiles save staff time and improves collections.

    In addition to these key steps, seeking outside assistance is also a highly beneficial approach to maximizing your budget. Offloading special projects to skilled billing expertise on a project basis is many times the answer agencies are looking for to solve billing challenges. Third party assistance doesn’t have to mean a full takeover, but rather a customized approach to finding more cash.

    One example: A Netsmart state client was not billing for medication because it was perceived as too complicated. They teamed up with Netsmart to create calculations within the billing process via their electronic health record (EHR). This automated billing process enabled them to bill for more than $3 million they had previously left unbilled due to a cumbersome process.

    While COVID-19 has severely impacted counties in many ways, you can help ensure your budget, revenue and claims processes are fully optimized now and for the future. With an intentional, data-focused revenue cycle management strategy and billing guidance, your organization can maximize revenue and focus on delivering life-changing services to those who need them most.

    For additional information or questions, contact Corey Harden at Netsmart, 913-242-6078 or

    Carol Reynolds is the Executive Strategist, Public Sector at Netsmart

    Erica Gregory is the VP & GM, Revenue Cycle Management at Netsmart


    The severe impact of COVID-19 is being felt throughout all sectors and placing an unexpected, unplanned strain on county budgets and revenue.

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