To everyone’s surprise, the Centers for Medicare and Medicaid Services (CMS), followed almost immediately by commercial carriers, expanded the use of telehealth to include the entire US effective in early March. This quickly allowed urgent and emergency care centers to absorb and manage potentially infectious patients for triage, as well as routine and non-emergent care without unnecessarily exposing providers or patients to COVID-19.
A fundamental change has been evolving as new, innovative technologies become expected by a tech-savvy patient population. While the intention may have been a swift response to nationwide stay-at-home orders during an all-inclusive public health emergency, it’s hard to see how telehealth, as now defined, won’t become standard operating procedures in the future.
Integrating Telehealth Successfully
Whether functioning as an ambulatory funnel growing a hospital’s catchment area or part of a group or corporate/retail model, urgent care centers are uniquely situated to take advantage of the relaxed telehealth guidelines and reimbursement changes. The very nature of the urgent care model allows flexibility, easy access, and convenience, and now with telehealth readily available, they should grow increasingly popular.
Once your urgent and emergency care organization has decided to implement a telehealth game plan, there are three areas where specific consideration should be paid to ensure successful integration and a solid Return on Investment (ROI):
Insurance Verification – Urgent Care Centers usually have a very deep bench of contracted insurers so that they can be all things emergent to all people. Telehealth, by its very nature, creates problems with verifying patient insurance and benefits eligibility since the entire process is done remotely, and most patients are considered new patients with no historical demographic information available.
By using advanced artificial intelligence and automation technology, real-time verification with complete benefit eligibility can be available before the patient’s care proceeds. Unless your organization is providing telehealth as a courtesy, these visits are now fully billable through the CPT E/M codes at the full rate for new and established visits and should be billed as such.
Patient Payment Portion – One of the benefits for patients when choosing an Urgent Care Center over the emergency room is the reduced copay that is customary. While CMS and many commercial insurers are waiving COVID-19 copays for testing and care, other types of care still carry coinsurance stipulations.
It is imperative to understand the potential patient costs and to collect that amount before rendering care. As part of an overall insurance verification strategy, patient portions due should be readily available in real-time.
Coding – Nimble and knowledgeable coding expertise is critical in making any telehealth integration successful. There are new Place of Service (POS) and Hosting Facility codes, as well as CPT/HCPCS and ICD-10-CM code variations that impact reimbursement, including virtual check-in and eHealth codes.
Overall, consideration of a third-party partner may be supportive as you experience an influx of patients either during the current COVID-19 pandemic or after when there is sure to be a wave of patients needing to be seen for health issues that were put off or pushed out. A partner coding team can scale up or down as needed, thereby removing that responsibility from the urgent care business team.
Without a doubt, telehealth for urgent and emergency care centers brings vast possibilities to provide convenient and efficient care for patients looking for easy access. With reimbursement measuring up to in-person encounter fees, telehealth is a welcome addition that allows centers to expand hours and create goodwill with patients without adding additional fixed costs or expenses, but growing the bottom line.
Contact us to learn more about automation and support that eases integrating telehealth into Urgent and Emergency Care Centers.