The COVID-19 pandemic has forced the healthcare system in the United States to adapt in ways it has never had to before. Despite COVID-19 causing much disruption this past year, it did highlight the benefits of telehealth and has only begun to show what is all possible for providers, payers, and patients when innovative technology for patient care and experience is effectively implemented. Telehealth has been around for many years within the healthcare industry, but was forced center stage in 2020 to help minimize patient’s exposure risk to COVID-19. Over the past year, this digital approach to care has been an essential component to mitigating the spread of the virus. Telehealth services may have kept people out of the typical healthcare setting they are used to, but it has also stoked important conversations about telehealth coverage and access to healthcare. 

When the onset of the pandemic occurred, the usage of telehealth services skyrocketed after the Center of Disease Control encouraged social distancing. In February 2020, the Center of Disease Control (CDC) issued a statement advising everyone and healthcare providers in areas affected by COVID-19 to adopt social distancing practices due to the ease of transmission, specifically recommending that healthcare facilities and providers offer clinical services through virtual means such as telehealth.  

“Trends in telehealth encounters during January–March 2020 were compared with encounters occurring during the same weeks in 2019. During the first quarter of 2020, the number of Telehealth visits increased by 50%, compared with the same period in 2019, with a 154% increase in visits compared with the same period in 2019. During January–March 2020, most encounters were from patients seeking care for conditions other than COVID-19. However, the proportion of COVID-19–related encounters significantly increased from 5.5% to 16.2% during the last three weeks of March 2020,” according to the CDC.

With the recent escalation of telehealth services and many experiencing the convenience of what it has to offer first-hand, chances are the high usage of telehealth will only continue and the capabilities will expand. According to a 2020 KYRUUS report, almost three-fourths of those they polled said they wanted virtual care to be a standard part of their care moving forward and half stated they’d switch providers in order to have telehealth options. 

Despite the many benefits of telehealth, it has come with challenges that providers, payers, and patients continue to navigate. These challenges have originated from the varying telehealth definitions between state and federal agencies and what care is or is not covered by payers. And if a particular type of care or test is covered, how long is it covered? 

Challenges for Providers: Technology and Timely Reimbursements 

When dealing with sensitive patient information, it has been essential for providers to adopt a telehealth infrastructure that is not only secure, but has an effective workflow design that compliments the quality of care a patient receives. For some health systems, especially smaller practices, adopting a new telehealth service or implementing improvements to an existing one has been a big financial investment. When considering a telehealth service, many immediately think that it only includes seeing a provider through a video conferencing platform. Video conferencing is only one of four ways providers can digitally assess their patients in order to determine if an in-person visit is required.

Medical coding and billing have always been an essential administrative task in the healthcare industry, but with more and more people utilizing telehealth services, providers need to ensure that they are being reimbursed in a timely manner so healthcare access and their bottom line do not suffer. Telehealth services have different coding and description of service requirements than an in-person record does. It is key for these coding options to be reflected correctly to ensure payment is not delayed to the provider and those who received the care can clearly understand what it is they are paying for and what has been covered by a health plan.

Challenges for Payers: Telehealth Coverage Expansion Plans

Prior to the pandemic, telehealth service coverage varied greatly because the evolution of equitable reimbursement has been slow to evolve over the years. Rates for telehealth not only vary from state to state, but there is also a delicate balance between state and federal policies. In March 2020, former President Donald Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act. The act granted limited powers to the Secretary of Health and Human Services to waive several key Medicare telehealth policy restrictions, allowing it to be used more widely in COVID-19 situations. However, the act only addressed the lifting of some barriers to using Medicare for reimbursement. This adjustment in telehealth policy highlighted a long-awaited easing of Medicare requirements that have been advocated for by the telehealth community for many years. 

In April 2019, Centers for Medicare & Medicaid Services (CMS) finalized policies that increased plan choices and benefits, including allowing Medicare Advantage plans to include additional telehealth benefits. These policies continued the agency’s efforts to modernize the Medicare Advantage and Part D programs, drive innovation and competition to improve quality among private Medicare health and drug plans. 

Over the past year, insurers across the U.S. have followed various schedules that waived out-of-pocket-costs, created care campaigns, and extended deadlines for telemedicine in order to support their members during the pandemic. These extensions in telehealth coverage helped those who contracted COVID-19 and those who did not. With the heavier utilization of telehealth, non-urgent patients were able to be assessed through video conferencing or a phone call to receive the expertise they needed to decide if in-person care was required. As the COVID-19 vaccine rollout advances, insurers have continued to find ways to take action to improve claim acceptance and overall access to care.    

Challenges for Patients: Properly Utilizing a Telehealth Experience

With telehealth platforms continuing to be fine-tuned, providers have to remain conscientious of the patient experience and what type of information is required for a positive patient outcome. According to the 2020 KYRUUS report, 72% of respondents had their first virtual care visit ever during the pandemic, with over 75% saying they were very satisfied with their experience. 

Despite there being an increase in patient satisfaction in telehealth platforms, there are still aspects of digital care that can be a pain point if the right education isn’t made available. Ensuring that patients have clear instruction regarding what to download, how to log in, and how to position the camera or media is crucial to patient engagement with their provider.

Signature Simplifies Healthcare Administrative Demands

When it comes to healthcare in the U.S., the more you can simplify any process, the better the experience is for providers, payers, and patients. With rising healthcare administrative costs being a leading concern within the healthcare industry, an innovative approach is needed to streamline communication and data management now more than ever. Implementing an efficient and effective workflow design that streamlines the demands of the healthcare administrative industry will ensure that the healthcare system infrastructure post pandemic can weather future disruptions and can improve upon current processes. 

When claims and coding are completed or resolved as efficiently as possible, providers are able to be paid on time and patients can avoid the stress of medical bill confusion. Investing in a partnership that uses the latest technology can help minimize errors in the billing process and can increase the rate at which claims are being filed. This leads to overall financial improvement for everyone involved. Signature Performance is improving not only our clients’ business but the entire healthcare industry by finding better ways to leverage technology and industry-leading processes which lower the cost of healthcare administration.

To learn more about how Signature Performance can help you or to request a consultation, contact our team today or follow along on our Facebook and Instagram pages to learn more about Signature Performance’s vision.