There will be lessons learned when we look back at the societal changes resulting from COVID-19, and the economic recovery will be felt for years. Throughout it all, the healthcare industry has been learning and adapting through fire. Confronted with challenges like providing safe, effective testing and treatment for COVID-19 patients as well as non-affected patients, keeping our healthcare workers healthy, and getting reimbursed for all of the hard work – solutions have been marshaled with typical American ingenuity and a dose of support from the Centers for Medicare and Medicaid Services (CMS) and commercial carriers.
While there is no way to know how specific beneficial changes, like telehealth, will fare in the future, we have learned that we can work together to find standard solutions to immediate problems. How will this look going forward? Will we be able to work in tandem with governmental agencies and insurance payers to solve ongoing issues like burdensome prior authorizations and unnecessary denials?
Stepping Out of the Box
Organizational decisions are experiencing a shifting paradigm in this new landscape. Quality and effectiveness of outcomes will be analyzed over and over as the smoke clears. Still, there will be some worthwhile advances that will shape the industry with sustainable benefits in the years to come.
Improved Transactional Automation—The healthcare industry and its unusual third-party payer system deal with complicated regulations, contracting constraints, and ever reducing fee schedules, and friction at every turn when securing patient care and reimbursement. In record time, the CMS and commercial insurance carriers have removed obstacles and create pathways to allow COVID-19 testing, treatment, and payment to occur with less resistance.
Through emerging technologies and advanced automation, we see avenues leading to improved patient care and clinical outcomes, but also less cumbersome day-to-day functions like prior authorizations or denials management. With artificial intelligence (AI) enhanced tools, the vast majority of these functions can be performed in real-time with support from highly experienced experts to navigate complex or unusual outliers.
Greater Focus on the Patient Experience—The healthcare industry has lagged behind consumer preference when it comes to adopting fully automated access. Patients, especially millennial-age and younger, want to receive and pay for their healthcare in the most expediently and conveniently way possible. New COVID-19 telehealth guidelines were expanded to reach patients throughout the United States, and that has opened the door and broken down any resistance simultaneously.
Moving into the future, as patients absorb more of the financial responsibility for their care, they will gravitate towards hospital systems and providers that can provide real-time solutions. Patients want to know that their insurance has been properly verified, what they are going to owe immediately, and will be willing to pay given a knowledgeable explanation and an automated payment portal.
Additionally, patients will be far less patient with prolonged processing of things like prior authorizations and may perceive systems and providers using antiquated manual systems as less competent all around. With AI-driven solutions, prior authorizations taking several hours to several days (or longer) will be outdated.
Scalable Response Teams—With wildly fluctuating care being provided during the COVID-19 outbreak, hospital systems and providers have had to become knowledgeable about the immediate scaling of personnel to handle not only the testing and care of patients but also to manage the complex and changing reimbursement landscape.
Many have turned to expert third-party partners for coding and billing support instead of trying to bring in temporary workers with little training or expertise. Whether for use temporarily during the COVID-19 crisis or as a long-term solution, these partners remove the training concerns and bring a 99% accuracy rate that greatly decreases AR management after the fact.
Even with the best-laid plans, most organizations and providers were caught short by the COVID-19 outbreak. Looking back over the initial response showed where there were cracks in the system, but luckily many solutions are already available and ready to be implemented, including advanced automation and AI-driven products with proven results.
Learn more about targeted automation and a scalable solution, which benefits your healthcare organization.