Revenue Cycle Management and Telehealth—What Are the Challenges?

The following us a guest article by Khalid Al-Maskari, CEO and Founder, Health Information Management Systems.

Now that COVID-19 has triggered an explosion of telehealth, more clinics are recognizing virtual patient care as an essential aspect of the integrated care model. According to a recent Global Industry report, the telehealth market expanded from $45 billion in November 2019, to $53.2 billion by May 2020. While its growth is insurmountable and its benefits numerous, clinics also need to consider the logistics of implementing an effective telehealth solution.

Revenue Cycle Management (RCM) is a critical component of a successful health care practice, and the same is true in relation to telehealth. Telehealth and RCM can either work together seamlessly, or make the care journey more difficult for patients, providers and administrative staff alike. To best integrate telehealth with RCM, it’s important to be aware of the potential challenges and to understand their solutions.

Not enough patient medical history

One of the key reasons why telehealth failed to gain significant traction pre-COVID-19 was the lack of knowledge providers had about their telehealth patients. The reason why this is key for RCM is because when providers don’t have enough information on patients to determine which ones require the most hands-on care, they can’t maximize their revenue cycles.

As the virus is forcing more patients to receive medical attention, providers need to know up-front which patients are the highest acuity. These are the highest-billable patients, and they’re the ones that should be seen in person. When clinicians have access to a patient’s comprehensive medical history, they can quickly evaluate which cases are the most likely to need in-person follow up care and which ones are best served by healing at home.

When clinics have an EHR that works simultaneously with their RCM and telehealth solution, practitioners can quickly assess patient medical history, schedule telehealth or in-person care as needed and bill properly without difficulty. Without this ability, clinics may also risk bringing potentially healthy patients into hazardous healthcare environments.

Limited understanding of telehealth billing codes

Billing for telehealth services was limited pre-COVID-19, but agencies have been quick to adapt to the changing times. The Centers for Medicare & Medicaid Services (CMS) recently released updated guidelines for billing professional telehealth services during COVID-19. These adjustments work to ensure patients can access medical professionals while minimizing risk for themselves and their providers, in addition to ensuring providers get reimbursed at the same rate as in-person care. But although CMS and private insurers alike have updated their billing codes, it’s not uncommon for providers to experience frustration when trying to bill accordingly.

One key reason for this is due to complex RCM integration with the clinic’s existing technology, or even because of no integration at all. Providers need a way to select the right billing codes without problems, and this is sometimes easier said than done when it comes to older, legacy EHRs. Even though telehealth has a history of claims deflection, this model is changing day-by-day, and EHRs that prioritize interoperability will continue to have the upper-hand when it comes to billing for telehealth services. When clinics have the tools to prioritize and bill telehealth and in-person patients properly and effectively, telehealth not only becomes cost-effective, but it can also prove itself as an efficient revenue stream for the practice.

Poorly equipped telehealth platforms  

Not all telehealth solutions are created equally—they need to be customized to each individual clinic. For this reason, practices that use makeshift virtual solutions are at a major billing disadvantage. Free versions of Zoom, GoToMeeting and more are incapable of being integrated with a clinic’s existing technology, forcing providers to enter data multiple times through their EHR and RCM tools. These free versions are also HIPAA uncompliant, although the OCR has currently suspended HIPAA compliance enforcement for multiple platforms.

Because telehealth is still a relatively new addition for some clinics, practices also tend to hang onto low-value telehealth tools because they underestimate what virtual care is capable of. And when the expectations are misaligned with the actual service offerings, providers can once again fail to bill properly, thus leading to increased claim denials and a slower revenue cycle. Telehealth has evolved far past low acuity care—current technology allows telehealth providers to take vital signs, diagnose more complex conditions and have multiple health practitioners on a call with a patient—all without meeting the patient in-person.

Interoperability is the key to a successful telehealth integration. When telehealth can work in tandem with the clinic’s existing RCM, EHR and more, clinics can unlock the full benefits of virtual care.