Even with schools closed and daily schedules turned upside down, patient access staff at Winston-Salem, NC-based Wake Forest University Baptist Medical Center are not calling out.

“They have made the necessary adjustments, and are making it to work every day,” says Monica Brown, MPH, associate director of operations for the Downtown Health Plaza and Winston East Pediatrics.

The problem is some registrars suddenly have little to do. All the work they normally handle at a hectic pace (e.g., registering people for outpatient procedures) is on hold. Registrars are going to be working fewer hours or relocated to other areas. “With a much lower volume of patients, we are having to develop a different staffing model,” Brown acknowledges.

At North Mississippi Health Services, “patient access has a great deal of down time,” says Carol Plato, vice president of revenue cycle.

Staff are no longer registering patients for inpatient or outpatient elective procedures; those are all canceled. They also are not collecting copays from emergent patients.

“We made a decision to hold off on point-of-service collections until the situation has passed,” Plato reports. However, staff continue securing much-needed revenue, but in a different way. Most are now working in the central business office, calling payers to ask for the status of unpaid claims.

“They did not need much training since they are used to speaking with insurance companies,” Plato observes.

Registrars also are busy performing a root cause analysis on claims denials. In the process of doing this, says Plato, “they are learning how much time it takes to correct errors.” Payment delays for previously submitted claims have become even more problematic. “With volumes so low and an increase in supply chain costs due to COVID-19, payers should pay claims faster and without denials,” Plato offers.

Some health plans have promised to forgive copays on claims that end up with a COVID-19 diagnosis. So far, the health system has not seen many of those. “State and federal legislatures should mandate that payers pay hospitals all outstanding claims immediately,” Plato notes. “Payers are actually saving money, while hospitals are struggling.”

The department is looking at the difficult prospect of cutting hours for patient access staff, possibly to 36 or 32 hours per week. “That has not happened yet. But if we don’t get back to normal visit levels soon, it will be a reality,” Plato says.