Optimize your midcycle for telehealth services

Telemedicine is now a permanent fixture in homes across America. A majority of healthcare organizations have established the technology necessary to facilitate virtual health encounters, but the financial components of telemedicine have been slower to stabilize. Billing processes and reimbursement procedures continue to evolve in both public and private insurance, leaving providers scrambling to fulfill the latest requirements. In this blog post, we’ll explore various strategies to optimize operations at each key inflection point in the revenue midcycle and set you up for long-term success.

Documentation

Accurately capturing patient situations in clinical documentation is critical, as it greatly impacts CMI.

Strategy: Along with other logistical information (e.g., date, category, patient location), note the start and end time for a telehealth visit clearly and accurately

One of the primary ways that documentation for telehealth visits differs from in-person encounters is the high importance of time records. Length of encounter is one way that payers can track level of care administered and determine appropriate reimbursement.

Strategy: Always (yes, always) capture all hierarchical condition categories

In a virtual environment, it can be easy to focus only on the most pressing concern. Failing to document all aspects of patient presentation (even if seemingly unrelated to the current need) can jeopardize coding and charging processes. Document chronic conditions, impressions, and rule-outs along with the usual diagnosis and evaluation result information.

Case management

When a patient has many existing chronic conditions or is admitted to the hospital, case management is engaged. Case managers help patients navigate discharge smoothly and ensure they transition to the right place with appropriate support.

Strategy: Get a full picture of patient’s ability to self-manage conditions or recovery

In cases where patients do not have the capacity or social support necessary to manage chronic conditions or recovery processes at home, case managers can deploy home services, transportation assistance and, of course, telehealth! Telehealth can be particularly useful in healthcare deserts and for specialty practices—breaking down physical barriers to quality care, improving appointment adherence, and expanding clinician capacity.

Strategy: Provide technical support, when necessary

Despite the accessibility that telehealth facilitates, many patients still encounter challenges navigating the technology space. Fortunately, this can often be solved with a bit of helpful education and some tutorials from a case manager. However, there are also cases where patients simply do not have high-speed internet or other tools necessary to utilize telehealth fully. In these situations, case managers can help determine the next best options (e.g., pivot to audio, deploy in-home consults).

Strategy: Proactively identify gaps in care—and track efforts to close them

As payers and providers alike shift more energy to value-based models, telemedicine can help clinicians meet important goals for population health and whole-person care. Equipped with cohesive, 360-degree data on communities and patients, you can proactively identify gaps in care and make meaningful efforts to close them with telehealth. Robust analytics capabilities also enable providers to track if their actions are having a measurable impact on patient compliance, risk and outcomes.

Coding

Documentation quality comes into play in a major way for coding. If something isn’t documented, you cannot code for it. Everything that the clinician writes is translated into codes that illustrate the visit. As telehealth evolves, accurate coding is indispensable.

Strategy: Invest in your coders

No matter the payer you’re working with, charges and reimbursements for telehealth all come down to the coder. Coders who know each payer’s guidelines for telehealth services in detail (e.g., what modifiers are needed?) are more prepared to fully qualify care for appropriate reimbursements. Invest in ongoing trainings for your coders, and regularly audit their performance to identify denial trends and provide extra education.

Strategy: Promote coder-clinician collaboration

In cases where information is missing from documentation, your coders and clinicians should have a great working relationship. Jumpstart the partnership by establishing easy paths of communication, secure data sharing, and integrated systems (e.g., your EMR, telehealth platform, and advanced data analytics tool).

Charge processing

As with coding, a well-executed documentation process becomes essential when we reach the stage of charge processing for telehealth visits.

Strategy: Always check the charges

Since each payer has different rules about what levels and types of care can be provided via telemedicine, it is critically important to keep careful logs of what occurred during the telehealth visit and what level of care was provided. Your chargemaster should compare this detailed report to the approved care levels each payer has endorsed in order to reduce the chance of denials and minimize payment delays.

Strategy: Equip clinicians with ongoing documentation education

If you’re seeing a spike or a trend in denied claims, dig into the data! With the right tools, providers can quickly identify if and how errors are related to documentation issues. Use this knowledge to provide feedback and resources to clinicians who are struggling with certain aspects of documentation.

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