Maximizing Telehealth Success: How to Optimize Operations & Revenue Cycle Management

Telehealth RCM

In COVID-19’s wake, providers’ financial recovery will be crucial yet daunting. U.S. hospitals and health systems stand to collectively lose $36.6 billion between March and June 2020 alone. Physician practices also face serious financial challenges as they recoup revenues that declined up to 55 percent and patient volume that decreased 60 percent.

Amid these hardships, telehealth has emerged as a widely accepted vehicle for care delivery – providing a way for healthcare organizations to recover lost revenue and patient volume while providing much-needed care. Among the many reasons for its patient appeal, including convenience and quick access to care, telehealth offers the social distancing requirements patients have come to know and expect.

When COVID-19 hit, providers raced to implement telehealth. More than 80 percent of physicians are already using it or planning to adopt it. However, to reap the most benefits, providers need to optimize telehealth across all processes, including administrative and financial fields. This will create greater efficiency, improve the clinician and patient experience, and increase revenue from both payers and patients. As a result, providers can have a strategic advantage that leads to increased patient loyalty and market share.

Even if you already offer telehealth, it can be beneficial to take a step back and ensure your comprehensive workflow – including all revenue cycle processes – is seamless and streamlined. Many telehealth processes differ from traditional care encounters, such as check-in, patient financial counseling, point-of-service collections and even moving patients from the waiting area to the clinical encounter. Mapping the end-to-end workflow will ensure you’ve adapted processes appropriately – fostering efficiency and a positive experience for clinicians, staff, and patients.

Equally important is ensuring your telehealth services are integrated with your revenue cycle technology. For example, the same workflows that are utilized for patient outreach, appointment scheduling, and coding, billing, and reimbursement processes should be applied to telehealth visits to ensure you’re providing an effortless experience for patients and maximizing reimbursement.

Staying Abreast of Changing Billing Requirements

The Centers for Medicare and Medicaid Services (CMS) expanded its list of payable telehealth services to include more than 80 additional codes during the pandemic. It continues to relax reimbursement requirements to enable greater use of telehealth, most recently allowing physical therapists and other providers to be reimbursed through Medicare and expanding coverage for phone-based services. Commercial payer billing rules also continue to change in response to the pandemic.

Knowing these payer requirements is critical to avoiding denials and maximizing reimbursement, but staying abreast of these changes requires substantial time and dedicated resources. Ensure you have internal staff or a trusted partner who can continually monitor requirements related to billable telehealth services, documentation, and coding updates. This resource should have experience interpreting CMS and payer rules and extensive knowledge about health plan coverage, state laws, and state and federal coverage requirements. They should understand how to maximize reimbursement revenue by leveraging all of your billable personnel and services.

Take steps to avoid denials and ensure accurate reimbursement by communicating any updates in coding and documentation requirements to both clinicians and revenue cycle staff. Make sure you’re leveraging technology as much as possible to ensure accurate claims submission; for instance, flag and hold telehealth claims so revenue cycle staff can conduct a final review and check for proper modifiers before submission.

Identifying and Exploiting New Opportunities

In addition to ensuring care is provided, telehealth can be strategically leveraged to capture market share and create differentiation. Use analytics to look at historical data and determine how you can expand services to better meet patient needs. Consider how telehealth can support new service lines or programs, particularly those related to preventive care and wellness.

One physician practice, for instance, responded to the pandemic by quickly launching a new chronic care management program that clinicians can implement via telehealth. This service, offered to patients with multiple chronic conditions, enables clinicians to check in with patients and make sure they’re adhering to care plans – and get reimbursed for doing so. At first, patients were hesitant because the program was new; however, because they were concerned about the spread of COVID-19, they became receptive, very quickly. As a result, the physician practice didn’t have to furlough a single employee, and their finances didn’t take a major hit.

Leverage any communication vehicles – advertising, opt-in text and email lists, e-newsletters, on-demand messaging – to educate patients and the broader community about your telehealth services. An integrated patient experience platform can be especially valuable in this endeavor, as it can automate ongoing communications with consistent, well-branded messaging. Using these communications as a proactive tool can encourage patients to schedule telehealth appointments and increase your patient volume.

Achieving Competitive Differentiation and Gaining Market Share

COVID-19 has irrevocably changed telehealth’s role in healthcare. Forward-thinking providers will leverage this as a strategic advantage – expanding their telehealth offerings, marketing these services, and maximizing reimbursement. Before it can be a strategic advantage, however, telehealth must be optimized with technology integration and best practice processes to create a seamless workflow. If you don’t have this knowledge in-house or internal resources aren’t available to help, engage a partner with proven expertise – otherwise, the window for capitalizing on telehealth may close.

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