Written By: Juli Forde
(3 min read) As healthcare providers continue to manage unprecedented challenges during the COVID-19 crisis, making the most of clinical resources is critical. To that end, the Centers for Medicare & Medicaid Services (CMS) regulatory waivers and new rules recently granted the U.S. healthcare system flexibility to expand telehealth. Every provider was suddenly faced with adapting to a telemedicine environment amid new administrative and reimbursement challenges.
Unfortunately, from a regulatory and reimbursement perspective, CMS is not the only authority. Each state governs the scope of practice according to different laws and consents. How can providers give good clinical care via telemedicine and maximize their opportunity to receive appropriate reimbursement?
With the explosion of telemedicine into every specialty, best practices are up in the air—how to schedule an appointment, receive insurance cards, get a driver's license, obtain history from a patient. How do we meet those requirements in the world of telehealth? Here are four best practices to consider.
Review your state’s regulatory environment
Review your state's regulatory environment to identify any practice limitations for telehealth. If your state has a parity law, determine whether it relates only to access via telehealth. Does it require that private payers reimburse a telehealth visit in the same manner they would a face-to-face visit? In addition, review requirements for consent. Does your state recognize only patient consent or patient consent for anyone in purview? Do they require a written consent or is a verbal consent sufficient? Is there licensing reciprocity? Pay attention to CMS guidance, but know what is allowed in your own state.
Review policies and procedures
Review your policies and procedures to address specific telehealth practices required to verify patient identity and insurance, obtain family history, and meet additional requirements. In a telehealth environment, the patient often interacts only with the doctor, not with staff who typically handle payment, documentation, billing, scheduling, patient follow-up, and other responsibilities. What if, in the rush to provide care for the patient, the doctor, or other clinician fails to capture certain required demographic information?
Ensure coding staff understands telehealth coding requirements
Provide resources to guide coders through the process of prompt and accurate coding to help ensure proper billing and reimbursement. The American Medical Association (AMA) recently published special coding advice during COVID-19 , a comprehensive guide including coding scenarios designed to apply best coding practices. In addition, it is important to review payer-specific coding and documentation guidelines.
Implement technologies to help capture patient information and promote optimal revenue
In today’s fast-paced telehealth environment, clinicians often need a way to go back after the fact to get complete insurance and demographic information. What if you saw the patient and never thought to ask about a change in insurance? What if you failed to get the patient's Social Security number but you have their name, date of birth, and address? During this time of disruption, many providers are implementing new technologies to ensure capture of timely, accurate information.
Insurance validation and discovery tools can easily identify primary and secondary insurance coverage, including Medicaid. In addition, automated updates related to payer coverage support claim accuracy and reduce processing time.
Demographic verification on the front end can ensure accurate patient demographic information and reduce claim denials, payment delays, and breach risk.
The ZOLL®AR Boost™ solution supports efforts to capture patient information and payment sources as healthcare providers continue to face clinical and financial challenges during the pandemic. Learn more about how it can help you optimize your AR right now.