COVID-19 and Managing the Revenue Cycle: What's Changed, What Hasn't, and What Do We Do Now?

Kevin Sharlow |


As we’re nearing the end of the second year of the COVID-19 pandemic, there have been significant impacts, both financially and operationally, on the American business landscape.  The healthcare industry, including its unique revenue cycle function, has not been spared these disruptions.  Such shifts in the normal paradigm can create stress and confusion, which can lead to a lack of focus and short-term, knee-jerk decisions that are not focused on the real goals.  While the pandemic has, in fact, resulted in real changes in the revenue cycle operating model, it has not changed the fundamental aspects of managing performance and delivering results.


First of all, there has been a material change in the financial performance of healthcare organizations. The pandemic, related lockdowns, and other safety measures resulted in drastic reductions in patient volumes, elective surgery procedures, and staffing pressures.  These factors directly impacted the revenue cycle through decreased billed revenues and cash flows, as well as deteriorating performance metrics.

Second, the pandemic very quickly impacted the day-to-day operating model in all industries, including healthcare and the revenue cycle in the form of a rapid shift to a remote/work-from-home model that involved the majority of traditional back-end revenue cycle staff.  Almost overnight, basic elements such as daily staff interactions, meetings & communications, and staff performance monitoring presented a much-changed dynamic and challenge for revenue cycle leaders.  While healthcare organizations focused on critical aspects of remote work, such as data security and equipment needed to support this new model, revenue cycle leaders found themselves faced with the challenge of staying connected with staff and continuing to deliver unchanged performance expectations.


As noted in the last sentence above, one thing that did not change was the level of performance expectations that healthcare organizations have on their revenue cycle operations.  However, and more importantly, the fundamentals of managing performance and delivering outcomes within the revenue cycle have not changed.  

As mentioned earlier, situations like the pandemic can serve to knock people off their normal course and become reactionary in decision making, and in some cases be used as an excuse for diminished performance.  While a remote workforce model presents some logistic challenges, it does not change the basic principles of staff oversight and performance management. These principles fall into two categories: Philosophical and Practical.

The Philosophical principles of revenue cycle management involve three tenets: 

  • Simplicity: designing solutions around the rules, not the exceptions, to maximize ROI (think Pareto Principle on steroids); 
  • Focus: eliminating all non-value-added tasks with a singular focus on driving towards the end goal (think cash flow);
  • Sustainability: holds for solutions, once implemented, will continue to reliably produce the intended results.

The Practical principles of revenue cycle management involve three pillars of driving staff performance: 

  • Productivity: every back-end function needs to have objective productivity expectations that are founded on industry standards and supported by a formal program to monitor and provide feedback;
  • Quality: similar to productivity, back-end functions need to have a formal quality audit program in place to ensure staff are executing their work tasks in a consistent and effective manner, and also to balance out against productivity expectations;
  • Workflow: simply put, this involves having the right work delivered to the right staff at the right time.  In today’s automated environment, this is typically accomplished through the use of work queues or other similar functions included in standard patient accounting systems.


Overall, the Philosophical and Practical elements of revenue cycle performance management have not been changed by the Covid-19 pandemic.  However, given the shift to a more remote operating model, effectively implementing and managing these core elements now has some unique, logistical challenges. So how do you successfully work through this environment and come out the other end a winner?  For that I’ll leave you with the following thoughts and predictions:

  • With the obvious cost savings and reported gains in productivity from remote staff situations, the hybrid (on-site/work-from-home) operating model is likely to become the new norm.  Embrace it.
  • Make sure that you address, embed, and execute the three Philosophical principles and three Practical pillars across all of your revenue cycle functions (if not, then the rest is moot)
  • Remember, these principles and pillars apply irrespective of operating model (on-site, remote or hybrid)
  • Effective, reliable analytic tools will be needed to successfully manage productivity and quality programs
  • New skills will be critical for line managers and supervisors to manage remote teams
  • Being “remote” will bring new opportunities and challenges regarding staff recruitment and retention
  • Organizations will be looking for a panacea for the remote model challenges (think “AI”). If you’ve been in revenue cycle long enough you know that these “shinny new objects” rarely deliver as promised
  • Don’t get distracted, stay focused, and remember what really moves the needle (don’t be so preoccupied with what you could do, that you forget to stop and ask if you should do)


Kevin Sharlow, Managing Director

Avid Consulting Group, LLC