Health care providers are encountering several problems stemming from the increase in telehealth usage, many of which are directly tied to the COVID-19 pandemic.
Many physicians are now working remotely as clinics have been partially or fully closed during the pandemic. These clinics need to do what they can to maintain profitability during this time.
The Office of Civil Rights (OCR) has relaxed some requirements and waived penalties for HIPAA violations against health care providers. Relaxing HIPAA requirements allows for the use of “in good faith” technologies such as FaceTime or Skype during COVID-19. Currently there is no expiration date to these new guidelines.
With OCR’s new waiver, it is easier to get the face-to-face technology set up the “new” telehealth way. What is not so easy, is making sure that services rendered translate to income for providers.
There are plenty of issues to consider:
- Configuration of your EMR and billing systems.
- What are you able to bill as telehealth activities?
- Medicare and Medicaid have some clear guidelines, but commercial payers are inconsistent at best.
- Stay aware of the patient’s perspective.
- What has changed for them when adjusting to telehealth?
- Should you bill for a phone call you previously did not bill for?
- Know your customers and do the right thing in their eyes. Make sure to keep their trust.
- Training all participants in the process.
- Providers need to understand the new services and be able to provide the appropriate documentation.
- Coders and A/R specialists also need to be aware of new billing expectations.
With the magnitude of unknowns, our recommendation is don’t worry. Answers are on the way.
In the meantime, we recommend you push what you can through your EMR and into your clearinghouse/claim scrubber with the information that is available.
Configuring your EMR to bill telehealth services might be difficult, so let your claim scrubber do the work and then adapt your other systems as time allows.
Don't worry, the payers will let you know when you're doing something wrong.
We can always count on payers to let us know when we submit a claim incorrectly.
As a clearinghouse, efficientC’s philosophy is denial prevention. We want to stop claims, fix them, and update our claim scrubber edits and change routines as we learn from payer responses.
Over time optimizing your clearinghouse/claim scrubber will help reduce follow-up work. Which in turn, limits claim touches, minimizes opportunities for errors, and will increase first pass yield.
As we all know, if a claim gets denied on its first submission, there’s a 40% chance that claim will never get paid. Which is why our strategy involves a little more work upfront to prevent more denials down the road.
This is a different time.
We don’t have all the answers on telehealth and related COVID-19 denials. The data is beginning to come in and tell us more about what we can and cannot do. Right now, all we can do is play by the rules we know of today.
One of our company values is being “flexible and adaptable to change”.
It is during times like these where we all need to embrace that mentality. Answers and clarity will come. Do what you can today and make decisions based on the information that is available to you.
Most of all don’t worry.
At efficientC we're working to provide you with the answers as soon as they become available. We are starting to see COVID-19 denials enter the revenue cycle. We are analyzing that information and making decisions that will help our customers. So, stay tuned.
If you have questions, give us a call. We will be happy to share what we know.
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We hope you can attend our upcoming webinar
We’ll be pulling together all the knowledge gained since the onset of COVID-19 as it pertains to billing and presenting it in a format to provide you and your organization with information to help navigate the changing landscape of telehealth and help get your through this pandemic.
What is efficientC?
As a leader in the denial prevention movement, we love sharing our story.
efficientC was born from a need for a better way to manage claims. Built by revenue cycle experts for revenue cycle specialists, we created a revenue cycle management tool to make your transition from a strategy of denial management to denial prevention seamless.