Provider Cash Flow Support

The coronavirus (COVID-19) is greatly affecting healthcare providers, with impacts that go beyond the challenges they face on the front lines of the crisis. These impacts may include material changes to typical patient utilization patterns and increasing labor, medical supply, and medical equipment expenditures and their related impacts to cash flow. In these uncertain times, payers may consider adopting different payment programs to support the financial stability of their provider networks.

Payment programs modeled off Medicare's Periodic Interim Payments (PIP) program may be able to provide a financial lifeline to the provider community as COVID-19 increasingly disrupts a providers cash flow. In addition to helping secure the strength of network providers, a “PIP-like” program could establish a set of partnerships to build upon as the crisis recedes.

A program modeled after PIP could see payers sending a regular, recurring advance payment to providers based on an average of historical claim volume from a determined historical time period. The advances would be offset by subsequent claims billed and approved for payment. This process could help stabilize cash flows, both now and potentially in the future, post crisis.

Our solutions

Baker Tilly has close working relationships with both providers and health plans, which enables us to understand how COVID-19 is disrupting the entire healthcare ecosystem. Our team of Value Architects™ also has extensive experience with provider/payer finances and revenue cycle optimization, and has also implemented “PIP-like” solutions in the health plan market.

Our professionals are here to assist you and your organization so that health plans and providers can continue processing current and past claims and collaborate to more effectively stabilize and predict the cash flows for providers. Our insights can aid providers in easing cash flow concerns so they can focus on protecting their professionals and treating patients affected by COVID-19.

Modeling/Data analysis

  • Conduct analysis to determine provider utilization pattern and cash flow impact from COVID-19, including projected ICU, PPE and ventilator utilization to inform detailed business rules of the advance payment
  • Determine time period(s) to use in order to model advance payment amounts and rules to periodically update any necessary future payments
  • Determine how long an alternative payment cash flow process will need to occur
  • Generate 13 week cash flow models to support short term planning and decision making

Provider engagement

  • Work with identified providers to review proposed processes and agree on business rules to support short term cash flow needs
  • Collaborate with providers on reporting expectations to support process execution
  • Proactive support during process adoption period

Transaction systems

  • Modifying health plan systems to intervene in current claim payment process and integrate with system created to manage advance process
  • Technology support within health plan systems to calculate, send, offset and track advances
  • Integration (process and/or data) with financial reporting systems

Reporting

  • Establish required set of reports that document process details sufficient to support all required accounting processes and stakeholder communication (health plan, provider and ASO groups as appropriate)
  • Establish additional monitoring reports to allow calibration of processes and rules over time

Our approach

Calculate

  • Calculate the average claim volume and associated net payment amount that typically occurs during designated advance time window

Advance

  • Advance calculated dollars to designated provider

Claims payment intervention

  • Health plan must modify claims systems to prevent claims payments in lieu of advance; provider must continue to process past and current claims, track the adjudications of the claims by the health plan, and reconcile PIP payments with claims billed/adjudicated to ensure accuracy of financial reporting processes

Offset advance

  • Provider sends health plan claims that would otherwise be paid against prior advances, frequency may be modified if both parties agree

Financial reporting and monitoring

  • Health plan produces and distributes reports to substantiate advance amounts, claim offsets and current balance positions; both parties execute required financial transactions; provider validates health plan reporting with its own assessment
How we can help

Coronavirus Preparedness Resource Center

Visit Baker Tilly's Coronavirus Preparedness Resource Center to access resources regarding the steps organizations can take to prepare for the impact that COVID-19 may have on their employees, customers and supply chain.