Telehealth Offers Much-Needed Revenue in Near-Term, but Future Reimbursement Is Unclear
At Augusta Health in Fishersville, VA, new registration processes for telehealth happened almost overnight. Now, facilities are making adjustments.
“We are learning to crawl before we walk,” says Andy Long, administrative director of cardiovascular services.
Previously, Augusta Health offered only limited telehealth services for specialty care. About 90% of care now happens virtually, a change that overhauled patient access processes. “It’s a shift in dynamics,” Long notes.
Once telehealth visits were underway, things did not always go as planned. “Due to nationwide demand, there were bandwidth and technological instability issues,” Long reports.
Patient access switched to obtaining registration information over the phone instead of in person. Helping all specialties bring their telehealth online was another challenge. “We have successfully worked through and overcome any glitches,” Long says.
Both registrars and patients have gotten used to telehealth. Going forward, says Long, “virtual medicine will be more widely used on a standardized HIPAA [Health Insurance Portability and Accountability Act]-compliant platform.” The department plans to offer web-based scheduling eventually.
Some things have not changed. Registrars still collect the same demographic data from patients. They verify insurance at each visit to ensure the hospital receives payment. “The data collection that occurs during the registration process is pretty similar in a virtual environment,” says Katie Adams, director of patient financial services.
Registrars no longer scan physical insurance cards. Instead, they confirm coverage electronically. “The expansion of telehealth services has been a major benefit to our organization, to supplement the decrease in face-to-face visits,” Adams says.
Most contracted payers are covering telehealth services. “But if and when this changes, there will be a need to verify specific benefit coverage prior to the visit,” Adams adds.
For now, hospitals receive the same payment regardless of whether a visit is virtual or in-person. “We are settling into the new virtual norm, and our payers are neutralizing reimbursement for virtual visits,” Adams explains.
Revenue cycle leaders are keeping a close eye on any policy changes that could affect reimbursement. “Unexpected claims denials are always a concern,” Adams says. The Centers for Medicare & Medicaid Services (CMS) issued clear expectations on how telehealth claims need to be handled.1 Health plans are a different story. “Some large commercial carriers are not following CMS protocols, and are hesitant to answer direct questions on their expectations,” Adams reports.
Departments fear the possibility of future claims denials since health plans cannot clarify their own requirements. “Many times, it forces us to be reactive instead of proactive,” Adams says.
Whether telehealth reimbursement continues is anyone’s guess. “We are waiting in anticipation to see if CMS and our contracted payers will continue to support telehealth services beyond the initial response to the pandemic,” Adams says.
Health plans could keep paying for telehealth visits. On the other hand, the health plans could revert to business as usual, and decide to pay for in-person visits only.
“If telehealth continues to be supported by our payer community, we will continue to offer it as an alternative care model,” Adams says. Health plans have made no long-term promises. Some payers allowed telehealth coverage for 90 days, with no guarantee of payment after that time.
“We are nearing that point,” Adams notes. “We have been asking if they will provide extensions. We aren’t getting clear direction.”
When patients are offered a telehealth appointment, they want to know whether their health plan covers it. “That assurance is difficult to give when the insurance companies aren’t providing it,” Adams observes. “The individual who suffers most from this lack of clarity is the patient.”
Because of the poor communication from health plans, patients worry about winding up with the bill. “We assure them we will continue to stand with them,” Adams says. “We will do everything we can to ensure they receive the services they need.”
So far, at least, there are no definitive answers. “We are thirsting for information from our payer community,” Adams adds. “In most cases, it simply isn’t there.”
- CMS.gov. Medicare telemedicine health care provider fact sheet. March 17, 2020.
During the COVID-19 pandemic, telehealth is surging in popularity. But due to nationwide demand, there have been bandwidth and technological instability issues for patient access departments trying to adjust.
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