Navigating a Post-Pandemic World: How Medical Practices are Moving Forward

With vaccinations on the rise and many Americans returning to work and school, what’s ahead for healthcare? We spoke with Bobette Flagel, Director, RCM Services at TriZetto Provider Solutions, for a deep dive into the pandemic’s impact on claim volume, billing & operations. Hear lessons learned over the course of the last year, plus easy-to-implement best practices that can help practitioners move forward.

The healthcare industry, like many others, was profoundly affected by the COVID-19 pandemic. As vaccinations increase and patients start to return to the doctor’s office, many medical professionals are asking an important question: “What comes next?”

We spoke with Bobette Flagel, Director, RCM Services, for a firsthand account of the current issues affecting healthcare practitioners. With the industry in the midst of recovery and optimistically looking toward the future, we discuss lessons learned, new challenges and easy-to-implement strategies to move forward.

Q: RCM experts from TPS work closely with medical professionals and have direct insight into the daily happenings at medical practices. What’s the state of the industry at the moment?

A: Practices are inundated with claims relating to vaccine distribution, plus the day-to-day claims and procedures that are on the upswing now that a normal cadence of appointments is being seen. Services that were once top of mind, like credentialing, are being put to the side. They know it’s dangerous to neglect their business’ needs and are just trying to figure it all out.

Q: What comments and concerns are you hearing from practices, hospitals and health systems?

A: The problems faced vary by specialty and size, but I think it’s safe to say that many are overwhelmed. Like professionals in other hard-hit industries, they are trying to figure out the unknown as they go. There are critical issues that need to be addressed, like growing A/R. They are looking for help with coding and prior authorizations too. The amount of claims are just through the roof. To put it simply, a lot of practices are behind. On the plus side, they are ready and willing to tackle the challenges.

Q: This raises an important question: What impact has the pandemic had on claim volume?

A: Claim volumes are exceeding pre-pandemic rates. From the RCM side, we have seen significant spikes. One client that comes to mind saw claims jump from 200 a month to 1,200 a month. Volumes are doubled, even tripled in some cases, because of delayed telemedicine claims or a new influx of vaccinations. If you think about it, there are never-before-seen facilities like pop-up COVID-19 testing sites and vaccination clinics at places that were once only pharmacies, like Walgreens, that are creating new codes and claim nuances.

Q: Many practices also seem to be dealing with low cash flow. How can they adjust?

A: By streamlining patient payment collection. Ask yourself what processes you can implement that will make it easier for patients to pay their bill. Consider adding functionalities like text-to-pay. I know TPS offers assistance with patient statements where bills are sent on the practice’s behalf, which has been a big help to many of our clients. If you think about, it can be a struggle to get bills out the door if your staff is working remotely, so practices are having us send their statements for them. Also, many practices lack the capacity to check eligibility, so they’re coming to us to check benefits so they can collect copays and deductibles up front. Simplifying these steps will only improve patient satisfaction in the long run.

Q: Telemedicine had a meteoric rise in 2020. What residual effects is it having today?

A: It’s funny because the term ‘telemedicine’ was unknown to the average person prior to last year, but now it’s a household term! Telemedicine’s convenience was immensely beneficial, there’s no doubt about that. However, there was definitely a learning curve on the part of the medical community. If you recall, many payers waived fees and payments like co-pays associated with telehealth in the early stages of the pandemic. While that was great for patients, it caused a few unknowns for providers. What should be collected upfront and what exactly should be submitted? There were also new codes created, which can lead to confusion and human error if the coder or biller is unfamiliar with the new number. We are seeing an increase in patient statements, because it’s time to collect on these delayed or denied claims.

Q: While telemedicine created efficiencies, it also upheaved the typical in-office appointment and the associated job functions. Is it safe to say that pandemic caused unforeseen staffing changes that have trickled into 2021?

A: Definitely. There was a lot of movement last year – downsizing and restructuring due to decreased appointments, or employees taking time off to stay home with school aged children and perhaps they have yet to return. Perhaps offices are still understaffed and trying to figure out how to make day-to-day billing run smoothly.

We’ve also seen instances of practitioners retiring or closing their practices. Maybe a smaller operation decided to accept the acquisition from a larger health system, or a doctor that was considering retirement finally hung up his hat, since it would be too hard to recover after the tumultuous year that was 2020.

Q: How can practices recover and get back to full operating capacity?

A: Taking an in-depth look at statements, denials and cash flow is the first step. Once there is a firm understanding of what’s coming in and out of the practice, so to speak, work can be done to tackle the issues. Maybe it’s hiring additional staff, if possible. Maybe it’s time to utilize outsourced resources. Whatever needs to be done to operate on all cylinders.

Q: What can companies like TPS bring to the table?

A: Expertise, industry insight and extra resources. With the current state of the industry, it’s an all hands on deck approach that works best. So how is that achieved? With adequate resources and solutions. TPS had a wide range of experts that can fit in where needed. A breadth of solutions covering everything from eligibility, patient payments and analytics also makes sure every box is checked so nothing falls through the cracks going forward.

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