Part II – Picking up the pieces: Shifting to the new normal and maximizing compensation

Jason Anderson
By: Jason Anderson
Date: May 05, 2020

So, You Implemented Telemedicine. Now What?

In partnership with Sonder Health, Avaap is providing a three-part series for healthcare organizations that rapidly moved to implement a telehealth solution at the onset of COVID-19 and have since dealt with a surge of virtual visits. Make sure to catch up on Part I of the series highlighting a few simple guidelines for starting your telemedicine program.  

Part II – Picking up the pieces: Shifting to the new normal and maximizing compensation

As we look for ways to restart daily life, healthcare providers are coming up with plans on how to safely bring patients back into hospitals and clinics to provide care. The reality is that things will not go back to the way they were pre-COVID-19, at least not in the near-term, and instead we’ll be presented with a new normal where patients and providers will be screened more regularly, PPE will be rationed, and hospitals will continue to isolate and treat COVID-19. A balance will need to be struck on how to effectively provide care while keeping the population safe and assuaging patient concerns about contracting the virus.

One thing that is certain is that we’ll continue to see telemedicine care at an increased level. There may, however, begin to be a cooling off period for telemedicine as we reach peaks in different parts of the country and resources are diverted back to in-person care. Healthcare organizations that quickly implemented or scaled-up their telemedicine services should take advantage of this time to ensure they receive proper reimbursement for care provided and begin to plan for a shift to a long-term telemedicine solution.

Many completed a telemedicine implementation in weeks, or even days, for what would normally be a months-long process. They may now be left picking up the pieces with bloated work queues of telemedicine claims, extra providers and staff that provided telemedicine services, and a slew of different workflows and technologies across their health system due to a lack of front-end governance. These will all need to be addressed as things shift to the new normal in healthcare.

telemedicine and the new normal

Apply for benefits from the CARES Act

The first thing that healthcare organizations should have done is to have applied for benefits from the $200 million appropriation of funds from the CARES Act Connect Care Pilot Program. It is not too late to apply if you have not done so already. The program provides funding for telecommunications services, information services, and devices necessary to provide critical connected care services. These funds are critical for healthcare providers to support the quick roll-out of their telemedicine services and scaling of those services, especially given the financial hardships most hospitals are experiencing.

The detailed requirements for being eligible to receive funds, apply for funds, and receive funds would take up many blog posts, so we’ll highlight a few key points of the process:

The program is available to both rural and non-rural care providers. CARES funds will be an added boost for rural providers and patients, who often are challenged with the basic needs of delivering telemedicine such as reliable broadband access.

Telehealth success metrics are a part of the funding criteria. As noted in Part I of our series, any telehealth program should have clear metrics and success factors to support efficacy, however it is made critical in order to achieve as much funding as possible.

Keep receipts for everything. While seemingly obvious, in the rush to implement amidst the pandemic, standard practices may not have been fully followed. It is crucial however to track and maintain documentation of all potentially eligible services for reimbursement.

Maximize reimbursement from telemedicine services

To offset the spread of COVID-19, Medicare has expanded their coverage of telemedicine services so patients can get access to care from their home, when and where they need it the most. One of biggest telemedicine barriers lifted in response to the COVID-19 pandemic are the temporary changes made by CMS allowing for payment parity between telemedicine visits and in-person visits. Additionally, CMS is providing Medicare coverage for more than 80 new telemedicine services. The allowances have been one of the biggest drivers for providers to expand telemedicine care during the pandemic, with some states also mandating parity for Medicaid and private payers. As with many telemedicine guidelines, each state provides its own rules on reimbursement, so, it is critical for administrators to continue monitoring the changing regulations.

Expanding access and coverage was a key lynchpin for the expansion of telemedicine as a viable solution for both providers and patients, however, many physicians and revenue cycle teams were not prepared for what the new encounters and increased volumes meant. With the rapid implementation and/or increased volume in telemedicine visits, we expect that many organizations will be left with large work queues of visits to code and bill for care management.

To help mitigate the potential reimbursement challenges, physicians should be provided a similar level of support for telemedicine visits as they would a new clinic or EHR go-live. Have a personalization template, provide cheat sheets, and make ongoing training and support available to help physicians capture the appropriate visit documentation and coding up front to reduce errors on the backend. Revenue cycle departments should also be prepared to divert billing staff to manage the increased telemedicine work queue volumes. They should be aware of the latest billing guidelines to minimize denials. On top of this, administrators should be actively negotiating with payers to get the best rates they can. It is not a certainty that payment parity will stay in place after the public health emergency, so you need to be making the case now that these visits will remain a viable method of care long-term and negotiate with the future in mind.

Adjusting to a new normal care delivery model

As social distancing restrictions begin to lighten, in-clinic visits will inevitably pick up again and reduce the volume of telemedicine visits we’ve seen over the last couple of months. The increase in telemedicine visits has only partially offset the decline in in-person visits. Hospitals and clinics will need to find ways to bring people back in to provide care and stabilize revenue. That said, telemedicine will continue to play a vital role in the care delivery process moving forward. Patients have found it to be easier than expected, and even after stay-at-home restrictions end, people will turn to this avenue of care. Digital health will increasingly be the entry point for patients to receive care.

Healthcare organizations will need to find the right balance both in the near-term and the long-term to support the new normal of care delivery. In the near term, the backlog of in-person visits will require clinic staffing schedules to ramp back up. Concurrently, the public at large will still be slow to go in for less-urgent care needs, keeping volume for telemedicine high. New entrants to the workforce, such as recent med students, should be leveraged to supplement staffing for less complex visits and specialties. In the long term, all services should develop a staffing model based on their new virtual versus in-person visit mix. This could include increased hours of availability, varying compensation based on care provided, partnering with clinical delivery telemedicine companies, and increased scope of practice guidelines for providers such as APNs and PAs.

Looking ahead

The COVID-19 pandemic has been a true change catalyst for the delivery and adoption of telemedicine. As organizations begin to wrap their hands around the surge of telemedicine visits in 2020, they should then turn their attention to the future. Our next post will discuss how to sustain and scale telemedicine services at your healthcare organization.

Subscribe to the Avaap blog for alerts or come back next week for part three, Looking Ahead: Sustaining and Scaling Your Telehealth Program.

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