The healthcare industry is adapting to the COVID-19 Public Health Emergency (PHE) at a record pace. Affecting everything from the ability to obtain adequate PPE, changes in care delivery (telehealth), and absorbing the gluts and surges of both emergency COVID-19 and elective or non-emergent patient care, healthcare providers are learning what it means to be hyper-flexible.
Patients and providers are navigating new and confusing insurance guidelines and expectations while facing the challenges of operationalizing telehealth and greatly reduced face-to-face contact for the foreseeable future. Further complicating matters, the US is experiencing an unemployment rate unseen since the Great Depression and, as more and more people lose their jobs, they also face losing their health plan coverage and are trying to understand how that is going to affect their futures.
3 Automation Opportunities that May Improve the Bottom Line
A key concern for everyone in the healthcare field during this challenging time has been how to remain solvent through the crisis period, whether providing care to the record number of coronavirus patients (and getting reimbursed) or postponing business from canceled elective and non-emergent procedures. Three opportunities for automating the healthcare payment lifecycle rise to the level of serious consideration:
Pivot Eligibility and Estimation Tools for Telehealth — When the Centers for Medicare and Medicaid Services (CMS), followed immediately by commercial insurers, gave blanket authorization of telehealth as a way to provide care and triage without face-to-face contact, operationalizing the process became critical. Tech-based eligibility and estimation tools have proven invaluable as a way to stay up-to-date and current with each payer’s current policies on cost-sharing and related information.
With an integrated solution, a patient information dashboard is made available and paired with the EHR/EMR making benefits information and patient portions due accessible to providers and staff members throughout the patient telehealth encounter. This allows accurate information to be collected, allowing smooth reimbursement for the telehealth visit or for any future procedures or surgeries.
Position the Coming Surge of Patients with Expedited Prior Authorizations — As hospitals and surgery centers open schedules and make operating time available, they are challenged with threading the needle in terms of getting countless canceled and postponed procedures scheduled efficiently. To maximize resources, they may expand hours, offer additional sites, or develop needs-based criteria to determine order and priority.
To ensure that your patients’ needs are met, implementing an automated prior authorization solution that operates in real-time without the all-too-familiar inefficiencies of a manual system allows your patients to be quickly processed and ready to go. A fully electronic process would determine need, gather the information, submit the request to the appropriate carrier, and monitor for follow up until completed. What used to take several hours to several days can now be done in near real-time.
Use Detection Technology to Identify Coverage — For many Americans, insurance coverage changes rapidly. Because of changes in employment, they may need to enroll in a new healthcare plan, secure a form of public assistance, or choose to file for COBRA benefits. This may significantly impact reimbursement over the next several quarters as the workforce adjusts to their new circumstances.
To guard against a growing bad debt/collections problem, institute an automated insurance discovery process that can significantly impact >60 days collections. Using artificial intelligence (AI) enables the ability to search massive clearinghouses of insurance payer data, unknown or undivulged coverage may be discoverable and amounts due rebilled to the appropriate carrier before exceeding timely filing deadlines.
There will be a time soon when things will return to a more normal flow and where outcomes can be anticipated. For now, whether adjusting to changing care delivery models, such as telehealth or managing third-party payment systems, embracing technology and automation solutions will allow you to support your bottom line as well as enhance your patient’s experience.
Contact us as you navigate through COVID-19 for RCM support for you and your patients.