How COVID-19 Will Affect Your Complex Claims

Posted April 7, 2020 by Matt Ellis

With the uncertainty we face regarding COVID-19, our team would like to share a few things hospitals and healthcare systems across the nation should keep in mind.

Revenue Cycle Leaders should be prepared for a decrease in volumes to some of their highest yielding claims. Specifically, two complex claims will be affected by this pandemic (Motor Vehicle Accident/TPL and Workers’ Comp), which make up two (2) to four (4) percent of a hospital’s net patient revenue. As an industry, we should expect to see a minimum of a 25% decrease to overall complex claims cash revenues in the short term.

According to The Detroit Bureau, rush hour traffic is down 87% in Los Angeles and 75% in New York.  This means hospitals should adjust their Motor Vehicle revenue accordingly – less people on the road means fewer accidents and a decrease in patient volumes through hospital emergency departments.  To be conservative, our expert team estimates that hospitals should plan on adjusting their forecasted revenues down by at least 25% due to a decrease in volumes at your facilities. Every state has a website to share motor vehicle traffic statistics in their state, and we encourage you to review your state’s data prior to changing your forecasting. (Ex.

Regarding Workers’ Comp, unemployment numbers have skyrocketed and will continue to grow throughout the upcoming weeks.  According to the Wall Street Journal, this virus could potentially cost seven million jobs across the US, and this decline will result in fewer Workers’ Comp claims. Hospitals across the country will feel the effect of this to their highest reimbursed revenue and need to consider adjusting accordingly. Every state has an unemployment website and should continue to monitor their stats throughout the pandemic. With that being said, states with stay-home bans, like Illinois, Ohio, Indiana, Minnesota, Wisconsin, Georgia, Tennessee, and Florida, etc. will continue to see Workers’ Comp claims as construction labor is exempt from these state orders, according to Engineering News-Record.  Other major industries like food and beverage are continuing to temporarily shut down and negatively impact the work comp revenue.

When it comes to the third complex claim EnableComp manages, Veteran Health Administration claims, hospitals are postponing elective surgeries, and Revenue Cycle Leaders have already begun to prepare for this loss in revenue.  Hospitals and health systems work closely with the VA to assist with specialized surgeries which are now delayed and impacting overall revenue.   Another item that we already see affecting hospitals across the country is a slowdown in transfers between hospitals and the VA systems.  Facilities need to be prepared to care for Veterans patients longer as the VA is mandating COVID-19 testing before any transfer occurs.  

Healthcare providers are on the forefront of this pandemic, and we are truly grateful to each one of you for risking your health and lives to fight this pandemic. We are committed to answering any questions regarding complex claims and are here to be your trusted advisor through this time.

Referenced Articles:

The Detroit Bureau

Wall Street Journal

Engineering New-Record