One year into the COVID-19 pandemic, revenue cycle leaders continue sorting out how it affected hospital reimbursement. The authors of a recent paper examined the financial strain COVID-19 has put on hospitals.1

“The implications for revenue cycle departments in the hospital setting may be latent or not fully understood until the pandemic is controlled or its effects are eliminated,” explains Adel Elkbuli, MD, MPH, director of clinical research, trauma at Kendall Regional Medical Center in Miami.

The revenue cycle impact is going to vary, depending on many factors. These include geographic distribution (metropolitan, urban, or rural), type of hospital settings, severity of COVID-19 and number of surges, and extent on ED visits and elective surgeries/ procedures. For revenue cycle leaders, says Elkbuli, “short- and long-term evaluations of the COVID-19 pandemic impact are necessary to make sound conclusions and determine any future actions/directions.”

Hospital revenue and reimbursement was affected in myriad ways. Many hospitals postponed elective procedures to expand capacity, resulting in significant net losses in revenue. Hospitals took action to respond to the pandemic (e.g., buying extra PPE).

Telehealth services expanded dramatically. Timely implementation of the Medicare Section 1135 Waiver affected the financial burden placed on patients and, in turn, affected the revenue cycle of many facilities.2 “Further studies are needed to accurately measure the exact impact of telehealth revenues,” Elkbuli says.

Hospitals took steps to educate trainees, physicians, and hospital billing and coding staff on proper ICD-10 coding for suspected COVID-19 patients. “This likely affected hospital revenue,” Elkbuli offers.

A confirmed COVID-19 diagnosis was the first step to invoking the 20% inpatient diagnosis-related group bump reimbursed by CMS for Medicare beneficiaries.

ED visits, and hospital admissions for stroke and heart attack dropped precipitously.3-5 The sudden decline in preventive medicine, care of chronic conditions, and healthcare in general “were far larger than could have been anticipated,” Elkbuli says. “There was a climate of public fear, leading patients with medical conditions to avoid seeking care.”

Hospitals saw a surge of uninsured patients (many with COVID-19) who lost their employer-sponsored coverage. “The ramifications of this pandemic will be felt for years,” Elkbuli predicts. “A number of hospitals and outpatient centers might not survive.”


  1. Boserup B, McKenney M, Elkbuli A. The financial strain placed on America’s hospitals in the wake of the COVID-19 pandemic. Am J Emerg Med 2020; Jul 9;S0735-6757(20)30601-X. doi: 10.1016/j.ajem.2020.07.007. [Online ahead of print].
  2. Rogers J. Coding telehealth services during COVID-19. Nurse Pract 2021;46:10-12.
  3. Boserup B, McKenney M, Elkbuli A. The impact of the COVID-19 pandemic on emergency department visits and patient safety in the United States. Am J Emerg Med 2020;38:1732-1736.
  4. Hall ME, Vaduganathan M, Khan MS, et al. Reductions in heart failure hospitalizations during the COVID-19 pandemic. J Card Fail 2020;26:462-463.
  5. Esenwa C, Parides MK, Labovitz DL. The effect of COVID-19 on stroke hospitalizations in New York City. J Stroke Cerebrovasc Dis 2020;29:105114.