In the patient access field, some changes with COVID-19 are just temporary. Registration will be performed on site again at some point, and elective surgeries will be rescheduled. Other changes probably are going to be permanent, says Richard L. Gundling, FHFMA, CMA. Here are some new practices with long-term implications for revenue cycle operations:
• Long-standing barriers to reimbursement of telehealth are gone. The desire for more telehealth always has been there, but payment was problematic. “It was hard to put a lot of resources into telehealth,” says Gundling, vice president of healthcare financial practices at the Healthcare Financial Management Association in Washington, DC.
With new waivers of restrictions, telehealth patients do not need to be in medically underserved areas. Practitioners do not need to use costly, Health Insurance Portability and Accountability Act-compliant systems. “It can be done with FaceTime or Skype now,” Gundling says.
Revenue cycle leadership can (and should) promote this change at their organizations, Gundling urges. The first step is to become fully informed about all the changes in telehealth billing requirements. These differ somewhat for Medicaid, Medicare, and commercial payers.
“Once CMS [Centers for Medicare & Medicaid Services] and the public sees that this can be done, that you can have some reasonable assurance on privacy and security, that’s something that can help facilities even after the coronavirus,” Gundling says.
• Departments are making a major push to assist those who are financially struggling. Educating patients with questions on insurance coverage or hospital bills is a perfect task for the new army of remote workers in patient access. “Working with payers to clarify which requirements are modified is also important,” Gundling adds.
While Medicare waivers cover a large group of patients, smaller health plans are more numerous. Each is going to provide its own answer on waivers regarding cost-sharing or prior authorizations. Asking health plans for clarification does not need to be contentious. “The message should be that we want to work together,” Gundling offers. He suggests that patient access start out by stating: “Let’s make a good faith effort that we’re going to keep the patients out of the middle of this.”
Advocacy for patients keeps the hospital financially viable. “People who have a great feeling about a hospital that tries to help them are more likely to pay in the future,” Gundling observes.
• Patient access is moving to touchless encounters. The typical onsite registration includes loads of hands-on interactions. People sign consents with pens or styluses handled by previous patients and staff. They hand insurance cards back and forth to be scanned, and fill in demographic information at registration kiosks using touchscreens.
“When we do get back to providing elective services, people are going to have a new perception of what’s appropriate now. They’re going to be much more concerned about what they touch,” predicts Kristine Anderson, vice president of project services at Pelitas, a Plano, TX-based provider of healthcare patient access technology solutions.
Compliance always is a top worry with touchless processes for consent. Some hospitals switched to asking registrars to obtain verbal consent from inpatients via phone. They also may have directed nurses to obtain an actual signature at a later point, with witnesses. Of course, documentation would exist for all of this.
However, moving forward, it is unclear how regulations will accommodate processes like these. “The challenge is to remain compliant. Not having an actual signature, whether it’s electronic or on paper, poses a problem,” Anderson notes.
Obviously, controlling the spread of disease is not unique to COVID-19. “This just created a more significant and severe response, one that could permanently change how we do things moving forward,” Anderson says.
For the revenue cycle, touchless ways to obtain signatures, collect patient liability, and gather insurance are top of mind. “Patient access and their vendor partners will need to be creative to find ways to do their jobs without requiring touch,” Anderson adds.