Telehealth has revolutionized the way reimbursement, billing, and payment processes function in the healthcare Industry. This blog investigates telehealth’s impact—especially in the aftermath of the COVID-19 pandemic—on revenue cycle management (RCM). From highlighting its positive influence to addressing some of the challenges it presents, this article provides an insightful peek into this virtual world.
The rapid growth of telehealth has significantly impacted healthcare revenue cycle management (RCM). As more patients use telehealth for routine care, chronic disease management, and urgent needs, healthcare organizations have adapted their RCM processes for virtual visits. Understanding this connection helps providers optimize revenue cycles for long-term success.
Telehealth expands patient access and convenience through video visits and remote monitoring. However, these services require updated RCM, like digital intake forms, new coding practices, and online insurance verification and payment collection workflows. Modifying RCM is crucial to maximize reimbursement for telehealth.
The rise of telehealth also increases patient encounter volumes for many providers. With more virtual appointments, organizations must process higher volumes of telehealth claims and bills. Adaptive, automated RCM technology is essential to manage the surging administrative workload. Optimizing RCM is vital to capitalize on the patient volume increases from telehealth adoption.
The COVID-19 pandemic led to a major increase in telehealth usage across the healthcare industry. Widespread stay-at-home orders and fears of viral transmission drove providers to rapidly transition in-person care to virtual platforms. Telehealth’s impact rose dramatically during the initial months of the pandemic.
This rapid growth revealed gaps in healthcare organizations’ revenue cycle management (RCM) processes. Providers struggled to keep up with billing requirements and payment collection for the influx of telehealth visits. However, those able to adapt saw increased revenue potential from the rise in virtual care. Refining RCM will be key for sustaining telehealth’s growth after COVID-19.
Telehealth introduces a transformative approach to healthcare delivery, enhancing cost-effectiveness and bolstering revenue streams for healthcare organizations. By mitigating unnecessary emergency department visits, telehealth significantly reduces overhead costs.
Moreover, telehealth’s impact on chronic care management has demonstrated cost savings. The efficiency of virtual services decreases the cost of conducting visits and allows providers to manage higher patient volumes at reduced labor expenses. This elevated efficiency translates into increased profitability, particularly when reimbursement rates for telehealth services align with those for in-person visits.
Furthermore, telehealth acts as a strategic solution to address revenue loss caused by last-minute cancellations and no-shows. The convenience and flexibility of virtual appointments contribute to improved patient adherence, particularly benefiting individuals who face challenges attending in-person visits. With more completed visits, healthcare organizations can capitalize on additional billable encounters and prompt payments, marking a pivotal shift in the landscape of revenue cycle management.
Telehealth integration with digital payment technologies creates faster revenue cycle turnover. Providers can instantly collect copays and outstanding balances through integrated payment portals after virtual visits.
Digital intake forms also improve upfront insurance verification for telehealth appointments. This reduces claims denials and labor costs associated with resubmission. Automated payment processing and verification streamlines the entire revenue cycle.
Increased convenience and transparency around pricing and payments through digital platforms also build patient trust and loyalty. Patients are more likely to pay their bills on time when the process is simplified and clearly communicated.
Patient no-shows and late cancellations can have a major impact on provider revenue. When patients fail to show up for scheduled appointments, providers lose the opportunity for reimbursement. However, telehealth offers a potential solution through improved convenience and access for patients.
By allowing patients to connect with providers remotely, telehealth increases flexibility around appointment times and locations. This enhanced access and ease of use leads to higher patient satisfaction with the experience compared to in-office visits. Consequently, telehealth can increase appointment adherence rates.
Additionally, telehealth gives providers more flexibility in managing schedules. The option to switch a percentage of appointments to virtual visits if in-office availability decreases allows providers to maximize patient volumes and productivity. Overbooking schedules to a certain extent is possible, knowing virtual visits can accommodate patients if needed.
Telehealth presents numerous avenues for improving the patient experience and providing a more accessible healthcare environment. Learn how to navigate telehealth medical billing in our informative blog.
Lack of fast, reliable internet access can reduce telehealth’s impact, particularly for vulnerable patient populations. Both patients and providers can experience dropped calls, freeze-ups, and poor video quality that disrupt visits. Healthcare organizations need to invest in upgrading their telehealth platforms and work with partners to subsidize internet access and devices for disadvantaged patients. They should provide technical support and training for patients and clinicians learning new telehealth technologies. Organizations also need to optimize platforms for mobile usage since many patients access telehealth via smartphones.
Many patients and clinicians lacked experience with virtual care before COVID-19. As a result, they may struggle to adapt their behaviors and workflows. Patients may not know how to use telehealth platforms, adequately capture health data like temperature readings, or feel comfortable with remote physical exams. Clinicians may need training on best practices for patient engagement, privacy, documentation, and diagnostic capabilities in telehealth. Organizations need comprehensive education on telehealth etiquette, capabilities, and limitations for both internal and external users. Hands-on training and post-visit surveys can identify ongoing knowledge gaps to address.
Rules around telehealth billing, documentation, and licensure vary significantly by state and payer. Navigating these complex regulations creates administrative burdens and cash flow issues if claims are denied. Providers should thoroughly review telehealth rules for each payer contract and specialty. Claims teams need training to ensure documentation supports telehealth billing codes. Organizations can work with local governments and insurers to align licensing and coverage policies and advocate at the federal level for more uniform telehealth regulations.
While telehealth technology already allows providers to replicate many in-person visit capabilities, there are also emerging tools to further enhance virtual care. Extended reality solutions can immerse patients in simulated medical environments to overcome physical examination limitations. Remote patient monitoring platforms capture real-time data between visits. Telehealth is also expanding into new care settings like ambulances, retail clinics, and home care. Other innovations include wearable devices, mHealth apps, and AI-enabled telehealth robots. As these solutions mature, they will require new RCM workflows to support optimal reimbursement.
AI and advanced analytics are transforming RCM by automating processes, predicting revenue risks, and gleaning insights from data. AI chatbots handle patient scheduling and billing questions to divert volume from human agents. Machine learning identifies documentation gaps and compliance risks to proactively prevent denials. Analytics provide visibility into telehealth usage patterns, clinical workflows, and patient trends to enhance efficiency. As telehealth expands the amount of patient data, these tools will be crucial to managing the added administrative workload. Healthcare organizations should partner with RCM specialists who offer AI-powered solutions.
The telehealth regulatory flexibilities introduced during COVID-19 are set to expire soon, raising uncertainty around long-term RCM implications. If telehealth restrictions snap back into place, providers may be forced to overhaul billing procedures, reimbursement models, and care protocols once again. Continued coverage parity for telehealth will be critical. Stakeholders predict ongoing lobbying around telehealth rules at both state and federal levels. RCM leaders should closely monitor policy changes and proactively communicate impacts to providers. With the right advocacy and innovation, telehealth can usher in a new era of connectivity, efficiency, and personalized healthcare experiences.
The future of healthcare requires resilient revenue cycle management. Partner with Horizon Healthcare RCM to transform your financial operations and maximize telehealth’s impact. Leverage advanced analytics, consumer-friendly engagement, and integrated systems to maximize revenue, lower costs, and focus on your clinical mission.
With proven RCM solutions tailored for telehealth, value-based care, and digital transformation, Horizon helps providers thrive now and into the future. Get in touch with us today to learn more.