The healthcare industry has experienced enormous change and uncertainty in 2020 and left many wondering how to prepare for the future. If there’s one thing this year has taught us, it’s that you can’t prepare for everything. Here we’ll focus on preparing your revenue cycle for the future of healthcare based on some changes we’ve seen take place this year.
THE EVOLUTION OF TELEHEALTH
Telehealth has changed drastically over time, especially throughout this global pandemic. Before the COVID-19 Pandemic, telehealth primarily focused on assisting a county outside of a Metropolitan Statistical Area (MSA) or in Rural Health Professional Shortage Areas (HPSA). After the pandemic, the CMS broadened access to Medicare telehealth services promoting Coronavirus preparedness and response supplemental appropriations act and section 1135 waiver authority. This meant that telehealth services must be accessible in any health care facility, including a physician’s office, hospital, nursing home, rural health clinic, or the patient’s home. Televisits, e-visits, telephone encounters, and virtual visits were additional billable services.
THE FUTURE OF HEALTHCARE IS TELEHEALTH
There are many pros to use telehealth, one being the cost. Telemedicine can reduce healthcare costs by up to 27% for those who pay for medical care. Telehealth makes having access to care easier for patients and collaboration easier for care teams. Telehealth is convenient for patients and offers you a competitive advantage over those practices that do not provide it.
It is essential to know some Telehealth policies that may become permanent:
- Permanent expansion of originating sites to include all geographic locations (including a patient’s home)
- Allowing any healthcare provider to provide Telehealth if they can bill Medicare for face-to-face services
- The need to provide better internet access to rural, underserved, and low-income communities and to continue coverage of telephone only (no video) services to help serve these patients
- Removing in-person requirements of specific services for check-in or renewal of care (hospice or home dialysis)
- Permanent removal of frequency limitations for services where temporary restrictions have been lifted
As you prepare for the future of telemedicine, know that some things will adapt. Check-ins may look different as a brief check-in via telephone or other telecommunications device to decide whether an office visit or other service is needed may occur. Regarding e-visits, both the patient and the provider will have access to communication through an online patient portal. Telehealth provides the opportunity for two way conferencing between the patient and provider for real-time consultation. And the patient’s health and medical data will be sent in real-time for monitoring.
TELEHEALTH REIMBURSEMENT AND AVOIDING AN AUDIT
The three best ways to avoid an audit are:
- Realize some remote visits are not telehealth
- Follow payer rules
- Conduct your own internal audits
For Medicare Telehealth visits:
- Define the service. Is it a visit with a provider that uses telecommunication systems between a provider and a patient?
- For new or established patients: the 1135 waiver requires an established relationship. It is essential to know that the HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.
- Know the HCPC/CPT Codes. Standard telehealth services include 99201-99215 (office or other outpatient visits), G0425-G0427 (Telehealth consultations, emergency department or initial inpatient), G0406-G0408 (Follow up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs).
For virtual check-in:
- A brief check-in between the practitioner and established patient over the phone to decide whether an office visit or other service is needed is required.
- Know the HCPCS and CPT codes:
- HCPCS codes G2012, G2010, G0071
- CPT code 99441-99443 (as of 3/30/30) for physicians, NP’s, PA’s (not POS 02)
- CPT code 98966-98968 (as of 3/30/20) for other qualified HCP’s (not POS 02)
- It requires communication between an established patient and their provider through an online patient portal.
- Know the CPT and HCPCS codes: 9421, 99422, 99423, G2061/98970, G02062/98971, G2063/98972
It would be best to document all televisits, virtual check-ins, and e-visits in the patient's medical record.
There is a minimum of required documentation elements, and those include:
- Proof of the patient’s initiation for the Televisit (either by verbal or written consent)
- Providers should contact patients to inform of the new Televisit rules
- Upon patient’s approval, the provider can proceed to the requested health care duties during the same call
- The name(s) and role of anyone present during a Televisit
- The chief complaint or reason for the Televisit
- Relevant history, background, and/or results
- Plan of care or next steps
- Total time spent on the Televisit service
HOW TO ALIGN YOUR RCM FOR THE EVOLUTION OF TELEHEALTH
- Evaluate how telehealth affects the patient experience
- Online appointment scheduling
- Paperless process
- Leverage patient portal and messenger
- Ensure appropriate and accurate documentation
- Dedicate someone to oversee telehealth changes
- Conduct internal audits
- Continue providing education and training
- Upgrading your RCM for maximum results
- Analyze claim follow-up processes to reduce denials
- Maintain strong communication with payers
- Fully optimize PM systems for automation to reduce errors
Analyze your telehealth operations:
- What technology is being used?
- Are you using a telehealth consent form?
- What type of service is being provided: Telehealth, virtual check-in, or e-visit?
- How are time-based encounters captured?
- How are you coding for the place of service?
- Rules are changing daily. Who is monitoring the Telehealth changes?
- How are providers being educated on these changes?
HOW TELEHEALTH CAN IMPACT THE PATIENT EXPERIENCE
Check-in with eClinicalWorks Telehealth solutions:
- Patients review their demographics
- Confirm their insurance coverage
- Sign consent forms
- Fill out questionnaires
- Review medications, allergies, hospitalizations, and surgical histories
healow Televisits no longer require login or downloads, there are no cost reminders, and no text logs either.
With Hellow2Healow, it requires patients to enroll for h2h on the patient portal. No appointment is necessary in the h2h platform. H2h offers call logs, calling cards, healow analytics, the ability to call patients with one click, is mobile-friendly, offers healow analytics, and offers a way to online book appointments.
TELEVISITS VS H2H
Feature Hellow2Healow Televisits
Requires appointment.......................N Y
No login or download required.......N Y
Online appointment booking..........N Y
Screen sharing.....................................N Y
TELEHEALTH & PATIENT EXPERIENCE ARTICLE:
According to the 2019 HIMSS report, nine out of ten healthcare organizations offer or pilot telehealth programs. Understanding why more healthcare providers embrace telehealth is vital, since value-based care and regulatory and reimbursement policies continuously must develop because of staffing challenges.
The same HIMSS article lays out these statistics:
- 61% offer remote patient monitoring
- 59% offer mental or behavioral health visits
- 55% offer remote sick visits
- 49% offer wellness visits via telehealth
- 42% offer consultations via text and/or post-discharge follow-ups
Technology will keep becoming increasingly important in healthcare, since it is a requirement for telehealth appointments and services. You need to ask yourself these questions: “How well prepared is my organization to provide telehealth in portal management? In storing high volumes of data? In offering provider facing communication platforms? In offering secure text-based platforms for patient/physician communication? And, in offering secure video technology to connect doctors and patients?”
There are going to be setbacks. Whether this is a problem on the patient’s end regarding a poor connection, lack of necessary technology, or apprehensive to telehealth appointments compared to face-to-face interaction.
While face-to-face interaction is still most physician and patient #1 choice for appointments, telehealth is becoming more widely accepted since technology can improve access and outcomes. This is good since telehealth is here to stay. In the HIMSS article, the senior director of market insights says, "The pace of telehealth adoption is speeding up...(It is) driven by a desire to expand access to care, make care more convenient, address talent gaps and shortages, improve care coordination, better monitor and treat at-risk populations, and expand population health programs.”
Relating to the desire to make care more convenient, expect that patients will demand more end-to-end delivery of care options, including home medication delivery, as televisits become increasingly popular. Even if this is problematic to you at first glance, building and enforcing trust is vitally important to sustain a healthy and continued use of online and home-based services. Point of care devices and home-based monitoring devices are digital tools that you can expect to become popularized in establishing remote communication between providers and patients.
It is vitally important that your practice requires a solid training and development program. Requiring that your staff is up to date in all alternative approaches, training, skill identification, measurement, and reinforcements to everyday practices is a great way to prepare for the future of healthcare.
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