By Fred Binczewski  MHA
September 1, 2020

TeleHealth, Denials and Provider Sustainability

As we have all moved cautiously through the past several months, the Covid-19 pandemic has changed and pushed the healthcare industry to new approaches and enhanced fluid gateways that now for many of us are the norm.

The explosion of TeleHealth is one of these main areas of innovative and progressive complexities for provider healthcare organizations and patient interaction and communication. For decades, healthcare organizations have used a myriad of staffing, software platforms and manual measures to suggest and interpret that their reimbursement from insurance carriers was hopefully accurate. Now, accuracy and accountability from the provider viewpoint regarding TeleHealth is incredibly visible and important to the bottom line. Healthcare denials now may be one of the top Key Performance Indicators to be scrutinized and worked by various departments, committees and staffing in the hopes of being resolved and hopefully prevented in the future. The livelihood of healthcare organizations may ultimately depend on this revenue integrity.

Healthcare organizations must make sure to review their contracts and the management of those contracts to now include TeleHealth as part of their contracted services with insurance carriers. Inaccurate or a lack of negotiated contract coverage may mean less or no reimbursement in many of these scenarios as they pertain to TeleHealth and the sustainability of an organization. On the provider side, they also need to scrutinize all documentation for proper claim billing and lessen the chances of claims being rejected. Because TeleHealth is still not completely tested from a claims denial standpoint and is certain to face future regulatory scrutiny as is apparent presently from Medicare, physician practices are wise to adopt an attitude of “over-documenting” patient visits. Foundationally, strategies should entail documenting everything that happens during an encounter – the objective, assessment, and any virtual examination or evaluation of the patient. The detail should also reflect the thought process of what a provider is monitoring and ruling out regarding a patient’s condition.  1 The provider organization must also include technology to serve the patient population with privacy and consent of use for these TeleHealth visits.

As healthcare moves forward into the future, the vision is to provide a more seamless technological approach for patient populations based on TeleHealth. This will also bring with itself a myriad of situations that will incite possible technical, informational or clinical denials. If these denials are not overseen by a denials steering committee as part of the revenue cycle team and daily monitoring in real time, these denials can easily take root in any of the departments of a typical healthcare provider organization. This practice can also lead to a slew of related and non-related issues only to diminish the true reimbursement and revenue possibilities in organizations serving the patient population.

In closing, the healthcare industry is experiencing a new repertoire for how it takes care of its patients and keeps its organizations sustainable for the future. We have only begun to understand the expectations that lie just ahead. Stay safe and diligent.

See you all next time in…….This Week in HealthCare

1 Hayes

Uprise Consulting Group, Inc., Eliminating Denials Today, Tomorrow and into the Future.

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