Let Us Discuss Telemedicine and RCM
The COVID-19 (Coronavirus) pandemic has disrupted and impacted the lives of every human being on the planet. Businesses have been shut down, the country is facing unprecedented numbers in terms of unemployment and the hospitals and health care systems in general are severely overloaded with a rising number of infected patients. Medical practices are either struggling to stay in business or are being forced to close down as they can’t handle the ever increasing dip in patient volume & collections.
During this grimm situation, telemedicine has unexpectedly surged in demand. Telemedicine has proven to be a sign of hope for medical practices and physicians in these trying times. For certain practices and health systems, telemedicine is the only barrier they have against closure. Whether in the form of a basic application or a software solution or a complete platform service, telemedicine is being rapidly implemented by providers.
So, in an effort to understand the importance of telemedicine and how it is being implemented, why is it in demand during this pandemic and most importantly, where is this technology headed once the pandemic is over. Iam a lead business strategist at BillingParadise gathered a group of top decision makers and experts from prominent medical billing companies and asked them about the scope of telemedicine & Telehealth and how it has helped them during the COVID-19 pandemic and most importantly what do they think about the billing and coding aspect of telemedicine & Telehealth services. We prioritized opinions and first-hand information from experts in the RCM field.
Kate Patskovska, CPB, Independent medical billing consultant @KR2 Medical Billing had this to say,Technically telehealth codes are supposed to be used for patients that are either unable to reach their provider or patients that have ESRD. The definition of the codes outlines that the provider can use them for established patients only. However, during COVID-19, the CMS has drastically expanded the telemedicine/telehealth benefit to include not only the telehealth codes but also the E/M codes, in order to include the “new” patient visits. In the last 2 months commercial payers followed suit and expanded their telehealth benefits to incorporate the new patient visits also. Some commercial payer changes included waiving member cost sharing for NON COVID-19 related telehealth visits, when seeking services from an in network provider. Also there are three other things to consider:
- The visits for surgeries/procedures will go down.
- Is the office of the provider equipped to conduct telehealth.
- And if telehealth is available, will the patient take that opportunity.
I personally had the discussions about telehealth with many patients (as an office manager for a specialist) and a lot of them would just opt out, citing that there were too many changes leading to confusion surrounding telehealth. This would lead to the decrease in patient visit(s). I think everyone is feeling the effects of COVID-19 on every level. The claims volume would also depend on what type of provider it is.” She further added, “Primary care physicians and mental health providers are the best clients now.”
Kira Hamill, Director of Revenue Cycle @Bayless Integrated Healthcare had this to say on how telemedicine has helped Bayless Integrated Healthcare, “No drop with Patient volume, staff, reimbursement. We offer virtual services for all lines of business, so we have been incredibly busy”. She further added, “We are fully staffed and the billing team is in tip top shape.”
Bryan Loomis, Founder & CEO @Viral Healthcare Founders had this to say about telehealth services, “I think currently telehealth is a great direction to go”. He further added, ” Yeah I think that’s a good pivot if you need revenue quick. This isn’t going to last forever (though it may last for a while) and at that point I’m expecting an outpatient boom – people who would’ve gotten knee replacements aren’t going to just not get knee replacements, they’re just going to wait until this is over. So I’d be preparing for that as well and if there are good ways you can help hospitals be well positioned for that.”
Julia Konovalov, Co-Owner & Client Relations Executive @Medical Business Partners had this to say from their experience using telemedicine, “Sure, we have been doing a lot with telehealth lately. I think it’s a good idea. Every practitioner should be doing telehealth visits now”.
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Dr Riley, ND, PhD, CEO & Owner @D&L Consulting Firm LLC, a physician consulting firm had this to say, when asked about telemedicine’s prominence during the COVID-19 pandemic, “Telemedicine is a viable and well needed avenue in healthcare. By using telemedicine as seen in our current state dealing with COVID19, we are able to see so many other patients that we weren’t able to see before. Telemedicine is the new norm.”
Ryan Beals, Founder & CEO @AmareVida, specialising in elder care. As a clinical consultant and a specialist in elder care, he had this unique perspective to offer on telehealth systems from the senior patients point of view, “I am involved in all the doctors appointments that are now being converted to telehealth”. He continued, “But guess what, what we think of as a great use of technology doesn’t mean there isn’t need for human contact and intervention with older adults who aren’t capable of utilizing a smartphone or are good historians of their care needs and issues when they get on the phone. So while this is great for our age group for convenience, the elderly who make up the greatest need and the greatest cost it remains an inconvenience and has to have care on the other end”
Stephen Dannenbaum, Ph.D., Owner & CEO – Clinical Operations/Integrated Healthcare @Occupation & Stress Intervention Services (OASIS), LLC, had this to offer on how telehealth systems are changing the healthcare systems, “Yes. As long as the executive order eliminates provider licensing restrictions across state lines, telehealth solutions will dramatically change our healthcare landscape.” When asked if hospitals should invest in new telehealth platforms, he said, “If an organization already has an established telehealth platform they probably will tend to continue to use it. That said, it is all about the business case. Can a new platform save money, increase productivity, etc.? ”
Lisa Diez, MA, Hospice Administrator @Intrepid USA Healthcare Services, had this to say when asked about the sudden increase in demand for telemedicine systems, “It definitely is a different time for anyone, but particularly in healthcare. Telehealth is in use across all platforms now.”
Kevin Bridges, VP of Marketing & Business Development @Enovate Medical, offered this, when asked about how telemedicine is helping them during the COVID-19 pandemic, “Many of our customers are leveraging virtual visits, aka telehealth or telemedicine. I was speaking with my contact at Vanderbilt and he said they were averaging 250 virtual visits per week prior to the pandemic but have averaged 6,000 per week since the pandemic.” He further added, “It ranges from a tablet (iPad) using Zoom to high resolution otoscopes and dermatoscopes. We work with VisuWell who is a turnkey provider. ”, when asked about how telemedicine is being implemented in their operations.
Holly (Bicknell) Hutchinson, VP of Sales @ARMCO Partners, summarised the need of telemedicine during the current COVID-19 pandemic with this nugget, “Billing and telemedicine are both essential especially now with COVID – 19.”
Reinaldo Rodriguez, President & CEO @Omnimanager, Inc., a company that deals in Medical management, billing & collections. He had this to offer when asked about how they were dealing with the telemedicine claims, “I have been using procedure code G2012 for brief communication technology based service with practitioners via telephone.”
Joshua Adams, Program Manager for Health Services @Swedish Medical Group, had this to offer, when asked about this opinion on telemedicine, “It’s interesting that folks do not see the benefit in telemedicine, and I’m curious to know the population that they serve. We have found it beneficial for Swedish to enhance our telemedicine efforts to ensure that we are meeting patients where they are at during this pandemic”. He continued, “I do understand that some may not find that insurance reimburses 100% but from what I have understood – temporarily, insurances are honoring the fees at 100%. I think it’s extremely beneficial for companies to take advantage of technology which will help patients and overhead in the long run.”
Peyman Zand, Vice President of Sales @CereCore, had this to say about about how billing companies can benefit from telemedicine during the COVID-19 pandemic, “My recommendation is for firms like yours to work diligently with payer organizations to establish good revenue recovery methods for your clients in telemedicine.” capable of utilizing a smartphone or are good historians of their care needs and issues when they get on the phone”. He further stated, “So while this is great for our age group for convenience, the elderly who make up the greatest need and the greatest cost it remains an inconvenience and has to have care on the other end.”
Bruce Worthington, The Interim CFO & Financial Planner @13SQRD, had this to say, when asked how medical billing & coding processes are handling telemedicine claims, “Many TeleMed services are currently receiving reimbursement at the office levels. The same codes are used with a different place of service code.”
Shawn Ekwall, MBA, Regional Manager @Barnabas Health Medical Group, provided an interesting insight through the experiences of his mother, who transitioned to telemedicine during the CVOID-19 pandemic. His insight deals with how medical billing companies can help Telemedicine practitioners, “Since covid she’s been doing telehealth but still does her own billing. With one platform it could potentially be seamless and therefore quite valuable to her to just focus on the treatment aspects and get away from billing”.
Danielle Nichole, Operations Leader & Business Manager @Rehab Access, has this to offer on their experience in using telemedicine, “I see opportunity and the hesitation with that idea. My clinicians at first mention wouldn’t see the benefits. I feel this idea could be a game changer during and after this pandemic.” She further added, “From a PTs perspective Telemedicine wouldn’t be beneficial for the treatment that we currently provide which is largely dictated by CMS, Private payers, etc and with the limitations and regulations prior to COVID I can see how a clinician wouldnt deem the idea beneficial ESPECIALLY having to pay for a product/service with reimbursement not very desirable. However, this would be ideal for patients in rural communities that find it difficult to commute at the frequency that is required to achieve optimal goals. This is a complex situation but overall this would allow great opportunity and resources for clinicians to broaden their platform and negotiate with insurance companies.”
Lisa (Calvert) Austin, Healthcare Consultant & A Specialist in ASC Development & Operations @Lisa Austin, had this to say about the prominence of telehealth systems during the pandemic, “I do not have a lot of experience in this area, but I do know that telehealth has exploded as a result of the pandemic. Depending on payor contracts, there may be opportunity for RCM to collect quicker and help remind patients to get in for follow-up.”, She further clarified, “I am not sure. I would develop a survey for medical facilities to determine breaks in the chain from what has been experienced so far and try to develop from there.”
Dale Hartis, VP of Business Development @Park Dansan, had this to offer regarding Telemedicine during COVID-19 and Telemedicine billing services, “Big fan of Telemedicine and think that since more use during virus as things move back to normal there will be a significant increase in usage. The billing issue will be much more nuanced but eventually payers, providers and billing support companies will reach compromise positions that everyone can live with. Government regulations could always interfere but I don’t think they will here.”
Lisa Blinzler Morrise, Executive Director @Consumers Advancing Patient Safety, offered this very keen insight while comparing telemedicine to in-person visits, “Telemedicine has increased exponentially with the pandemic. With improvement in payment, many options exist for specialty services. Intermountain has an existing model you may want to explore. Ultimately, telemedicine is one option for care (and follow up may be a good area to pursue), but it will not and does not in and of itself supplant in person care. Just like FaceTime is used as well as messaging and voice in personal relationships, but some things just have to be in person. Hope that helps.”
Charmia Smith, E.R. Admitting Specialist @Hopedale Medical Complex, had this interesting opinion to offer on the effectiveness of telemedicine in ER cases during the COVID-19 pandemic, “I mean I think the reason why telemedicine doesn’t work is because the doctor can not examine the patient and has to take hypothetical guesses over a phone. Though some cases may work in your favor, what about cases where crucial care was needed. It could be too late for the patient.” She supported this opinion by offering more details on her experience in working in the ER during peak times of the pandemic, “I work in the ER Dept and people who are having other issues Non-Covid, are scared and they still come in after telecall or prompt care visit”. She further added, “There’s so much to learn to make a person business grow that asking may formulate a plan where money can be made at all aspects. However we have to probably take surgery’s on healthcare and ask some small groups about what is their preference Telemedicine or Telemedicine in-person with a PCP. Or do you just go when you’re feeling ill?” This helped shed some much needed light on the conundrum a user faces while opting for telemedicine.
Chris Husted, President @DENmaar mHealth, LLC, had this to say, when asked about how medical practices are managing during the pandemic and how telehealth is aiding them, “Depending on the specialty of course, but if telehealth is possible then the doors are open.” When asked about the scope of telemedicine post-pandemic, he said, “Telehealth will be the way forward even post pandemic for a lot of people I think.”
Jessica Stoner, Owner & Billing Specialist @Maximum Medical Billing LLC., had this to say when asked how popular telehealth systems have become during the pandemic, “Yes providers have been doing telehealth now.”
Haidee Graves, COC, CPC, Medical Coder @Kalispell Regional Healthcare, offered much needed insight and perspective on the medical coding aspect of telemedicine, “I work as a coder in an urgent care under the hospital and we are coding telemedicine. Since the pandemic I’ve been coding telephone and telehealth. They are pretty much like the same as E/M coding. But they have some documentation requirements as well like it has to state the provider verified verbal consent from the pt. To have healthcare visit via telehealth/telephone. It also has to state the total time of visit.”
Melissa Clark, CCS-P, CEO @Outsource Management Group, LLC., had this to say when asked about whether medical practices should transition to telemedicine services, “I say, go for it.” She further explained on how she and her company has aided providers in transitioning to telemedicine during the pandemic, “We provide them with all the Medicare information, best practices etc., but with most clients, it depends upon their specialty as to whether or not they’re seeing the same patients.”
Karl Johnson, Division President @MTBC, said this, when asked on how to manage the revenue dip due to the loss of patient volume during the pandemic, “Yes, volume is off for many. We developed a Telehealth application a few years back and many providers are using it.”
After reaching to decision makers across leading medical billing companies, I reached out to someone in-house, someone widely considered as a pioneer in Revenue Cycle Management and in my humble opinion a true maverick of the medical billing & coding industry:
Sivakumar Sadayappan, CEO @BillingParadise, being the CEO of a medical billing company he had this unique perspective to offer on how a medical billing & coding and RCM intelligent company can aid medical practices, “COVID-19 hit all our clients really hard. The sudden dip in patient volume was staggering, but our clients quickly adapted to the new COVID-19 reality and transitioned to telemedicine.” He further added, “ From our side we provided them with complete telemedicine software support, billing & coding services designed specifically for telemedicine. For a couple of our clients, we even set-up their telemedicine platforms and provided free training programs to ensure that they can comfortably transition to telemedicine.” When asked about how else a medical billing company can aid their clients during this grim time, he responded, “We did not stop with telemedicine support, we went a step further. See, You can have the latest tech and it still won’t mean a thing if it does not reach the right people. So we stepped up and came up with some innovative patient marketing and ensured that our clients could help the people in need and as an unexpected result we gradually aided our clients in getting their patient volume back up. We made sure that patients understood that their doctors can provide them with safe healthcare during the COVID-19 pandemic.” When asked about what to expect post-pandemic, he stated, “We are focusing on Telemedicine billing and coding support along with IT support, COVID-19 related billing, Remote Patient Monitoring (R.P.M) and a lot of other smart RCM products. But, for now I can definitely say this, in the near future, get ready, cause we are about to unveil a product that defines cutting edge technology, so stick with us and don’t miss out on being a part of something truly great.”
What BillingParadise Has Inferred & Learned From These Experts
Thus far the consensus is that Telehealth & Telemedicine has a bright future and its demand will continue to grow. The general opinion of other healthcare professionals is that virtual health will not just be important during the crisis, but will be extensively used post crisis as well. If anything the crisis has simply shown how important telemedicine is. Most notably, telemedicine has been an indispensable tool that enabled medical practices to transition and optimize their practice during the pandemic.
Rightfully recognising the obvious benefits telemedicine & telehealth services has to offer during the COVID-19 pandemic, the government has introduced several relaxations and waivers to enable physicians to easily implement telemedicine services. However, it is also important to note that there is no confirmation so far, that these waivers will be in place post pandemic. On the bright side, it has certainly made it much easier to convince the government to implement laws that are favourable to telemedicine services.
It is no exaggeration to say that telemedicine has acted as a lifeline to several medical practices, by ensuring that they can keep their doors open and treat their patients during these turbulent times. So on the whole, it is safe to say that telemedicine and telehealth systems have a bright future.
Our clients at BillingParadise can attest to the fact that our telemedicine platforms and services have truly aided the survival of their business and practice. With a turnkey software solution and an easily deployable telemedicine platform, medical practices can sustain their collections rate. In addition we offer end-to-end RCM solutions and we provide coding and billing services for telemedicine practices.
