Inmediata

Blog – Telehealth May Be the Best Way to Increase Patient Access & Improve Reimbursement

Our last Telemedicine dashboard update included detail showing that overall encounters decreased while telehealth visits climbed to unprecedented levels for telehealth.  The report came out on 08/18/2020.  Our dashboard of over 9,000 providers now shows a steady increase in patient visits, but volumes are still 25% below pre-pandemic numbers.  We’ll need to continue to monitor this to determine whether it’s the new normal or whether the provider’s need to work harder to promote telehealth.  Our last report showed that the daily peak for telehealth was 12,700 visits on May 4th.  Although telehealth visits have trended down as much as 20 to 30%, on July 23rd telehealth visits spiked to over 13,100 reaching the highest single day telehealth peak for 2020.

With the Centers for Medicare and Medicaid Services (CMS) reimbursing for remote care models, adoption of telehealth has continued to rapidly advance as physicians strive to overcome barriers to continuity of care and maintaining operations amid stay-at-home orders. 

For some practices, telehealth is still unchartered territory that poses some notable risks for reimbursement.  Providers must adopt best practices and have processes in place that ensure complete, accurate capture of documentation necessary to support coding and billing activities. Doing so will not only ensure billing compliance, but also provides a boost to the bottom line at a time when it is desperately needed where overall encounters have remained below the inception of the COVID-19 pandemic. 

Here are some Telehealth Reimbursement Best Practices:

  • Documentation – Continue maintaining an electronic record for each patient encounter to document your interaction, including any assessments and treatment plans.  Ensure your staff are kept abreast of policy or billing changes as payers continue to update their policies which often follow CMS guideline as well as coding recommended by CPT™.   CMS HCPCS/CPT Codes
  • Proactively Monitor Telehealth Claims – Financial metrics, such as total billed claims, along with their 1st pass rate, the number of denied claim lines specific to telehealth should be monitored and addressed quickly to avoid missing any timely filing or appeal deadlines.  The difference between procedure codes billed and paid should be analyzed and trended by payer and denial type on an ongoing basis as the payment terms continue to evolve.  Even small changes from month to month could be statistically relevant and may merit a deeper analysis.  Most reports required to do this exist or can be built using the reporting features in a practice management system or clearinghouse.    
  • Increasing resource bandwidth – Operating a medical practice becomes more complex with every passing year due to extensive regulations, coding updates, changes to payer rules, performance and quality measures to track that can significantly affect reimbursement.  When issues occur, partnering with a company to manage the billing & coding of your claims may be the ticket need to streamline administrative processes required to do the extra work often required to get paid.  Partnering with billing vendors may also be helpful in practices where the staff is being required to do things not focused on patient care.  An option to consider is Inmediata’ s billing service called SecureAR, which offers a best in class billing solution that’s delivering proven results. Read more about the benefits of outsourcing your RCM.
  • Keeping up with the rapid change of Payer Reimbursement Policies – Maximizing payments for telehealth services provided requires a continuous awareness and monitoring of changes to the policy and regulatory environment.  The regulation of the telehealth industry continues to trend in a favorable direction; however, interpretation of the rules can vary tremendously from one place to another and from one payer to another payer.  Misinterpretation or delays in identifying payment variances can often cause a meaningful hit to reimbursement.  To stay up to date visit www.cms.gov.
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