Revenue Cycle Management in the COVID-19 Era: From Crisis Response to Sustainable Financial Health

Revenue Cycle Management in the COVID-19 Era: From Crisis Response to Sustainable Financial Health

Table of Contents

COVID-19 did not just strain clinical capacity. It disrupted the economic engine of healthcare. Elective volumes fell, payers rewrote policies in real time, and thousands of revenue cycle staff shifted to remote work almost overnight. Many organizations are still dealing with the financial “long COVID” of that disruption: delayed payments, aged A/R, inconsistent telehealth billing, and fragmented workflows.

For independent practices, group practices, hospitals, and billing companies, the question is no longer how to survive the initial shock. The question is how to construct a revenue cycle that can withstand continued volatility, new care models, and rapid payer rule changes without sacrificing margin.

This article outlines a practical roadmap to build a more resilient, sustainable revenue cycle during and after COVID-19. Each section focuses on business impact, operational change, and the specific actions RCM leaders should take now.

1. Rebuilding the Revenue Engine Around Shifting Service Mix and Telehealth

COVID-19 permanently changed care delivery patterns. In-person elective procedures dropped, chronic disease visits were deferred, and telehealth became a primary channel instead of a niche add-on. Many organizations rebuilt their schedules, but left their revenue cycle built for a pre-pandemic service mix. The result is chronic undercoding, inconsistent telehealth reimbursement, and misaligned cash flow forecasts.

Why it matters

If your coding, charge capture, and contracting assumptions are still oriented around pre-COVID volumes and visit types, your financial projections will be wrong and your margin will erode quietly. Telehealth visits typically have different allowed amounts, different cost structures, and different no-show behavior compared to in-person care. Without deliberate redesign, you can grow telehealth access while shrinking profitability.

Operational implications

  • Visit mix shifts (virtual vs in-person, inpatient vs observation) directly affect CPT/HCPCS distribution and revenue per encounter.
  • Telehealth coding rules, modifiers, and place-of-service choices vary by payer and have evolved several times since early 2020.
  • Legacy charge capture workflows often assume physical paper, on-site staff, or batch processes that do not fit virtual or hybrid care.

What RCM leaders should do

  • Build a post-COVID service mix baseline. Compare 2019 vs rolling 12-month data: visit counts by modality, procedure mix, payer mix, and revenue per visit. Use this to reset revenue expectations and staffing models.
  • Standardize telehealth coding and documentation. Create payer-specific quick reference guides that include covered telehealth codes, required modifiers (for example 95, GT), allowable POS options, and documentation requirements.
  • Formalize telehealth scheduling rules. Require eligibility verification at scheduling for virtual visits, including modality and platform rules, to avoid non-covered encounters.
  • Monitor telehealth KPIs monthly. Track virtual visit denial rate, average days to payment, and average reimbursement per telehealth encounter by payer and specialty. Use trends to drive focused retraining or contract discussions.

RCM leaders should treat telehealth and other new care models as product lines with their own economics, not just variants of existing office visits.

2. Converting Payer Volatility into a Managed Policy Intelligence Process

During the height of COVID-19, payers issued frequent bulletins: waiving cost sharing, expanding telehealth, changing testing codes, then rolling many of those provisions back. Although the pace has slowed, the pattern remains. Payer rules for virtual care, COVID-related services, and even certain ancillary services are adjusted far more frequently than before.

Organizations that still treat these updates as “FYI” emails risk denials, underpayments, and compliance exposure.

Why it matters

Each policy change is effectively a change to the “rules of payment.” If your teams do not translate those updates into specific changes in registration scripts, coding logic, and claim edits, then internal processes lag behind payer expectations. The outcome is a predictable spike in avoidable denials, manual rework, and aging A/R.

Operational implications

  • Unmanaged payer updates often lead to inconsistent use of modifiers, wrong place-of-service codes for telehealth, and misapplied cost sharing rules.
  • Contract changes related to COVID-19 may affect reimbursement for testing, vaccines, monoclonal therapies, or post-acute transitions and can linger in the contract long after public health emergencies end.
  • Staff become cynical when they receive “update blasts” that never translate into clear process changes or job aids.

Policy intelligence framework

RCM executives should formalize a lightweight but disciplined process:

  • Centralize policy intake. Assign responsibility to a single function, such as managed care or RCM operations, to ingest bulletins from Medicare, Medicaid, and top commercial payers.
  • Map every change to revenue cycle touchpoints. For each update, document impacts on registration, authorization, coding, charge description master (CDM), claim submission, and patient billing.
  • Update tools, not just people. Embed changes into EMR/PM system configuration, payer-specific claim edits, CDM pricing, and patient estimate tools. Relying purely on staff memory is high risk.
  • Track impact. When you implement a major policy change (for example new codes for COVID booster vaccines), monitor related denial rates and average allowed amounts before and after implementation.

A practical benchmark is that for every high-impact payer bulletin, your organization should have a documented change ticket and a measurable outcome, such as fewer denials or faster payment.

3. Aggressively Rescuing A/R While Building a More Predictable Cash Curve

COVID-era disruptions left many organizations with two distinct A/R problems: a legacy backlog from 2020–2022, and a structurally unstable current A/R driven by fluctuating volumes and payer behavior. Simply “working harder” is not a solution. You need a targeted rescue strategy for aged receivables, coupled with better upstream prevention and forecasting.

Why it matters

Cash is still the primary shock absorber for labor inflation, supply chain costs, and technology investments. Dollars trapped in 120-plus day A/R cannot fund staff retention, automation, or service expansion. At the same time, overemphasizing backlog clean-up without fixing root causes just recreates the same problem in 12 months.

Operational implications

  • Payer staffing shortages and backlogs increased response times, making traditional 30, 60, 90 day follow-up cycles less reliable.
  • Incomplete or inconsistent follow-up strategies across specialties and payers lead to uneven recovery, even within the same organization.
  • Billing offices that stayed fully on-site while the rest of the organization went remote often faced higher turnover and recruitment challenges.

Three-part A/R strategy

  1. Stratify A/R by collectability. Build a matrix that segments A/R by age bucket, balance size, payer, and denial / no-response status. Prioritize:
    • Clean claims that have simply not been paid within payer-timely standards.
    • High-balance accounts with correctable denials.
    • COVID-related claims with documented payer communication that can support escalations.
  2. Deploy specialized follow-up teams. Create dedicated pods for high-yield workflows, such as Medicaid, Medicare Advantage, and top commercial payers. For many organizations, a hybrid model that uses internal staff for complex escalations and a trusted offshore or nearshore team for high-volume, lower-complexity follow-up yields the best balance of cost and control.
  3. Rebuild a cash forecast model. Use historical patterns from the last 12–18 months, not just pre-pandemic data, to project expected cash by payer and service category. Validate forecast accuracy monthly and refine assumptions related to denial overturn rates and average days in A/R.

Key metrics to monitor

  • Gross days in A/R and net days in A/R, segmented by payer and location.
  • Percentage of A/R over 90 and over 120 days.
  • Denial write-off rate vs denial overturn rate.
  • Cash collections as a percentage of net patient service revenue.

For many organizations, partnering with an external billing or RCM firm for focused A/R projects can accelerate improvement. One of our trusted partners, Quest National Services, specializes in full-service medical billing and revenue cycle support that can help reduce denials and stabilize cash flow, especially for practices that lack internal bandwidth for intensive A/R clean-up.

4. Protecting Patient Relationships While Addressing Rising Self-Pay and Bad Debt

Beyond payer behavior, COVID-19 amplified patient financial stress. Layoffs, coverage changes, and rising deductibles left more balances in self-pay status or moving quickly into bad debt. At the same time, clinical teams were managing high acuity and burnout, which made financial conversations harder to prioritize.

Why it matters

Overly aggressive or inconsistent patient collections harm satisfaction scores, online reviews, and referral patterns. Overly lenient or unstructured policies drive write-offs and bad debt. The only sustainable answer is a patient financial experience that is accurate, predictable, and empathetic, supported by clear policies and modern digital tools.

Operational implications

  • New COVID-specific billing rules (for example coverage of testing and vaccines) created confusion for patients and staff, especially when rules differed by payer or changed over time.
  • Traditional paper statement cycles are poorly aligned with how consumers expect to manage bills, especially in a remote or hybrid environment.
  • Front-end staff often lack up-to-date scripts to explain financial responsibility for telehealth, virtual check-ins, or complex imaging tied to COVID-related evaluations.

Patient financial care checklist

  • Clarify COVID-related benefits at registration. For any service that may be COVID-related (testing, treatment, follow-up), verify coverage specifics and cost sharing while the patient is still engaged, and document this in the EMR.
  • Offer digital-first billing options. Provide text and email statements, online payment portals, and payment plans that patients can enroll in without a phone call. Track digital adoption rate as a KPI.
  • Train staff in empathetic scripting. Equip front desk and call center staff with language that frames financial discussions as part of care, not a separate “collections” function. For example: “Let us walk through what your plan is likely to cover and what options you have if the balance is difficult right now.”
  • Define clear escalation paths. Establish objective criteria for charity care, discounts, and payment plan terms, and make them transparent. This reduces staff inconsistency and perceived unfairness.

Track patient financial metrics such as bad debt as a percentage of net revenue, average payment plan size and duration, and call abandonment rate for billing phone lines. These are lagging indicators of whether your policies are realistic in the current economic environment.

5. Making Remote and Hybrid RCM Operations Truly Work at Scale

What began as an emergency work-from-home pivot has become a permanent operating model for many billing offices. Remote and hybrid teams can be highly effective if they are supported with the right tools and governance. Without that support, you will see inconsistent productivity, opaque accountability, and rising error rates.

Why it matters

Revenue cycle is a volume business. Remote work can expand your recruiting footprint and support 24/7 coverage, but it also makes it easier for bottlenecks and process breakdowns to go unnoticed. Inconsistent connectivity, unsecured home networks, or ad hoc workflows can also introduce HIPAA risk.

Operational implications

  • Traditional “management by walking around” no longer works for monitoring productivity, quality, or training needs.
  • Varied home environments affect staff focus and schedule adherence, which can impact payer call windows or batch timelines.
  • Security controls must move from physical to logical (for example device management, VPN, multi-factor authentication, and role-based access).

Remote RCM operating model

  • Standardize technology. Ensure all staff have organization-managed devices, secure VPN access, and consistent internet requirements. Prohibit use of personal email or cloud storage for PHI.
  • Implement workflow and productivity tools. Use queue-based worklists, integrated tasking within your PM/EMR, or RCM workflow platforms that can assign and track tasks by user and time. Avoid managing work purely via email or spreadsheets.
  • Redefine management rhythms. Schedule daily huddles, weekly performance reviews, and monthly deep dives. Share key metrics such as claims worked per FTE, denial overturn rates, and unresolved worklist volumes to keep teams aligned.
  • Invest in continuous training. Use short virtual trainings to cover new payer policies or telehealth changes. Track completion and include case-based assessments, not just slide decks.

Many organizations find that a blended model with some on-site staff handling mail, scanning, and complex walk-ins, and a majority of RCM functions remote, provides the best cost and continuity profile. The key is consistency of process and visibility, not physical location.

6. Making Financial Reporting a Strategic Tool Instead of a Retrospective Document

During COVID-19 surges, many CFOs and RCM leaders were operating in “incident command” mode, focused on immediate staffing and cash concerns. Now is the time to rebuild financial reporting in a way that helps leadership anticipate revenue risk, allocate resources, and prioritize initiatives. Static month-end reports are not enough in a volatile environment.

Why it matters

Without timely and actionable revenue cycle analytics, leadership relies on intuition or incomplete anecdotes. That leads to underinvestment in high-impact areas such as denial prevention or digital front door, and overinvestment in low-yield projects. In a post-COVID environment where margins are compressed, misallocated capital can be fatal.

Operational implications

  • Revenue cycle teams often produce long reports that are rarely read end-to-end and do not clearly link metrics to decisions.
  • Payer and service-line level variation in performance may be hidden by top-line metrics.
  • Front-end and mid-cycle leaders may not see how their work concretely affects cash and margin.

Decision-focused RCM reporting

At minimum, RCM leaders should deliver a concise monthly “RCM performance pack” that includes:

  • Core financial KPIs. Net days in A/R, cash collected as a percentage of net revenue, denial rate and denial write-off rate, bad debt, and cost-to-collect.
  • Payer-level insights. Top 5 commercial and government payers with trends in denials, underpayments, and average payment timelines. Highlight any COVID-related policy changes affecting these metrics.
  • Operational levers. Productivity and quality metrics for key functions (eligibility, authorization, coding, charge capture, follow-up) with commentary on drivers and remediation plans.
  • Forward look. Forecasted cash for the next 60–90 days based on current A/R stratification, known payer delays, and any upcoming contract or policy changes.

Each section should end with clear ask-level guidance for leadership. For example: “To reduce rising denial write-offs with Payer X, we recommend funding one additional authorization FTE and accelerating configuration of pre-service eligibility checks for high-cost imaging.”

7. Turning COVID Lessons into Long-Term Revenue Cycle Resilience

COVID-19 exposed every weak joint in the revenue cycle: outdated technology, dependence on manual processes, poor payer communication, and underdeveloped analytics. It also forced rapid experimentation: telehealth scaling, remote work, automated eligibility, digital billing, and more. The organizations that will thrive are those that convert their best crisis responses into standard operating practice instead of sliding back to pre-pandemic habits.

Why it matters

The next major disruption may not be a pandemic. It could be a large payer contract termination, a cyber incident, or a regulatory overhaul. A resilient revenue cycle is one that can flex quickly without losing visibility or control.

Concrete actions for RCM leaders

  • Codify your COVID-era innovations. If you successfully deployed automated eligibility or new telehealth workflows during the pandemic, formally document them, assign ownership, and integrate performance metrics. Avoid reverting to manual workarounds.
  • Invest in targeted automation. Focus on processes that are high volume and rules driven, such as eligibility checks, claim status inquiries, and basic payment posting. Automation here reduces vulnerability to staffing volatility.
  • Stress test your revenue cycle. Model “what if” scenarios, such as a 20 percent drop in elective volume, a temporary payer outage, or a surge in a particular service line. Validate whether your current workflows, staffing, and reporting would cope, and identify gaps.
  • Align governance. Ensure revenue cycle, finance, operations, and IT meet regularly with a clear agenda that includes payer updates, volume shifts, and technology roadmap. COVID blurred departmental lines. Keep the best aspects of that integration.

Finally, recognize that you do not have to solve every challenge alone. External partners, from consulting firms to billing companies, can bring process discipline, benchmarking, and capacity that would be costly to build in-house.

If your organization is ready to move beyond crisis management and build a more sustainable revenue cycle, start by prioritizing one or two high-impact levers from this article: telehealth optimization, A/R rescue, or payer policy intelligence. Define metrics, assign owners, and review progress every 30 days.

For organizations seeking hands-on support with complex billing, denials, and A/R management, working with experienced RCM professionals can be a powerful accelerator. One of our trusted partners, Quest National Services, specializes in comprehensive medical billing and revenue cycle services for practices navigating evolving payer requirements and post-COVID demand patterns.

To discuss how you can apply these strategies in your own environment, or to explore whether an external partnership makes sense for your organization, you can contact us for a deeper conversation about your specific revenue cycle challenges.

References

(Note: The discussion above is based on industry patterns and regulatory changes observed since the onset of COVID-19. For specific payer or CMS policies, always refer to the latest official guidance.)

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