Telehealth reimbursement risks and benefits

1

• Telehealth reimbursement risks and benefits

2
Telehealth reimbursement risks and benefits
Costs of health care have been rising over the
past few decades, and consumers are seeking for
different alternatives in order to minimize care
costs. Some of the patients skip doctor visits
and some of them consume generic drugs. Moreover,
most of the patients ask for different ways to
reduce costs. Owing to this, medical communities
as well as technologies are thinking about
telehealth as one of the cost-efficient
alternatives over conventional health
care. Additionally, the COVID-19 crisis drives
health care providers to shift towards telehealth
at a rapid pace. Before the pandemic, the Centers
for Medicare and Medicaid Services (CMS)
restricted Medicare reimbursements especially for
virtual services to a confined set of situations
due to which patients are still needed to go out
to avail health care services. According to the
American College of Physician Telehealth Survey
2020, about 24 of ACP members are utilizing
e-consults on a regular basis. Moreover, it has
been witnessed growing implementation of remote
monitoring and remote care management technology.
For a number of practices, telehealth is an
unexplored category that has significant risks
for reimbursement. Health care providers must
keep all the processes in line, which ensure the
correct collection of documents in order to help
billing and coding activities. By doing this, it
will not only make sure billing compliance but
also give a lift to bottom-line when it is
required the most.
Medical Billing Services in Oregon
3
Telehealth reimbursement risks and benefits

• However, implementation of telehealth can cause
  many challenges let us understand one by one
  about telehealth reimbursement risks and
  benefits.
• Telehealth reimbursement risks
• Documentation Risk
• As telehealth process is not tested from a claim
  rejection point of view and in the future, it is
  expected to face some sort of regulatory issues.
  Fundamentally, strategies should encompass
  everything, which occurs during patient visits
  such as evaluation, virtual examination,
  objective, and assessment of a patient.
• The detail must mirror the thought process of
  what a provider is supervising and about the
  condition of patient. On the other hand,
  documentation while using telehealth must mirror
  visual and audio capabilities and contain
  patients consent proof to utilize technology
  (e.g. Skype, Zoom).
• Important documentation risk areas, which can
  impress claim approval, are as follows
• Length of conversation
• Emergency room or outpatient consultations
• Date, time and place of service
• Follow-up visits

Medical Billing Services in Oregon
4
Telehealth reimbursement risks and benefits

• Appropriate use
• Follow-up visits
• Misdiagnosis
• As far as telehealth is concerned, the risk of
  misdiagnosis is greater as compared to in-person
  health care. Additionally, there are no stringent
  guidelines regarding telehealth hence quality of
  care may differ from provider to provider.
• Misdiagnosis has the potential to increase the
  overall costs as it refers to incorrect treatment
  and prescription. As per the Centers for Disease
  Control and Prevention (CDC), one out of three
  antibiotic prescriptions is unnecessary.
• Apart from this, if a telehealth service is
  unable to identify the diagnosis, patients may be
  recommended to visit the ER. If these visits are
  not required, patients as well as the general
  healthcare system could bear the extra cost.
• Training and infrastructure development
• Rebuilding responsibilities of your IT Staff and
  buying telemedicine equipment consumes time and
  money. Training is important to design an
  effective and efficient telemedicine program.
  Furthermore, restructuring your facility is a
  must for smooth telehealth implementation.

Medical Billing Services in Oregon
5
Telehealth reimbursement risks and benefits
Medical staff, practice managers, and physicians
require to be trained on a new system in order to
make sure a strong return on investment.
Telehealth enables to reduce your staff
requirements that lead to minimizing the overall
operational cost of your facility. Payment and
compliance regulations One of the major
challenges in telehealth reimbursement is
inequality in payment. Reimbursement and coverage
for telemedicine services might differ from
in-person consultation. However, there is no
constructive equipment to enforce payment parity
law, which is passed in the 28 states. This
could violate the motto of telemedicine, which is
to decrease health care costs and increase
penetration of services, and dishearten providers
from providing telehealth owing to the
uncertainty of comparable payment. Reimbursement
policies, healthcare laws, and privacy protection
rules effort to maintain with this fast-growing
industry. As a provider, you want to promote best
practices when impending telemedicine. Telehealth
reimbursement benefits Convenience According to
Ciscos survey 74 of the consumers open to the
virtual doctor visit. Addition of virtual care to
your practice provides patients on-demand and
simple care as compared to time-consuming and
high-cost in-person encounters.
Medical Billing Services in Oregon
6
Telehealth reimbursement risks and benefits
Telehealth could be a prominent tool in the
remote locality patients in such remote
locations can easily access care as per their
convenience. Tools such as online management
systems, smartphone applications, and video
conferencing engage number of patients with
healthcare providers than ever before. Healthcare
savings and cost-effectiveness Observing
services, electronic health records, and remote
analysis predominantly, decrease healthcare
service costs and saves money for you, payers,
and your patients. In addition to this,
telemedicine also declines unneeded non-urgent ER
visits and avoids transportation expenditures for
routine checkups. Apart from general
cost-savings, telehealth can support in order to
enhance revenue performance by attracting a large
number of patients, turning on-call hours into
billable time, and decreasing no-shows. Moreover,
it is highly beneficial for healthcare providers
who are willing to work under the work-from-home
model. Easy access to specialists With the help
of telehealth, patients from rural and remote
localities have quick and more convenient access
to specialists. According to the National Rural
Health Association, in the U.S., there are only
30 specialists available behind 100,000 people
on the other hand, the number is quite bigger for
an urban area that is 263 specialists. These
patients suffer from appointment delays and lack
of access to specialists for complicated diseases.
Medical Billing Services in Oregon
7
Telehealth reimbursement risks and benefits
Telehealth provides greater access to a number of
patients to multiple specialists. Apart from
this, you can refer you, patients, to the
particular specialist as per their requirement
without location constraints. Enhanced patient
experience When patients are dedicated to their
personal healthcare goals, it results in reduced
costs and enhanced health. Interacting with your
patients via telehealth may help them to manage
their appointments as well as care
schedules. With more engaging patient
experience, you can guide your patients about
different ways to live a healthy lifestyle. One
of the major advantages of virtual visits, it
assures patients about the involvement of
providers in their treatments. Additionally, it
makes much simpler for them to report early
warning symptoms, reach out with questions, and
schedule a follow-up appointment in order to
ensure they are on the correct path. If you are
keen towards minimum claim rejection then
outsource your billing and coding
responsibilities. We are one of the prominent
medical billing and coding service providers in
the country. We have a dedicated team of coders
equip with knowledge of medical billing and
coding guidelines. Together we can avoid coding
mistakes and revenue loss. With our billing and
coding capabilities, you can effectively focus on
your patients without stress. For more details,
fill free to contact us.
Medical Billing Services in Oregon