Do you want to expand your patient base across state lines through virtual visits? If yes, understanding how revenue cycle management (RCM) in telehealth settings works is essential.
This guide will help you master it! We discuss the key challenges and best practices. Thus, if you want to learn more about revenue cycle optimization in digital clinics, continue reading!
RCM Challenges for Telehealth Practices
The following are some of the key challenges providers encounter while trying to handle RCM in digital clinics:
Ever-Evolving Payer Policies
When it comes to reimbursing telehealth services, policies significantly vary across federal programs and commercial payers. To name a few:
- Every payer will reimburse for telehealth encounters at the same rate as in-person visits. As a result, keeping track of which insurance carriers offer 1:1 payment parity is a constant administrative struggle for medical practices.
- Besides, many telehealth practices operate across state lines. This means you have to stay updated on state-specific payer policies that dictate which services are eligible for virtual billing.
Modifier & POS Misuse
Coding accuracy does not end with selecting the most precise procedural code. That is, you must also ensure that you append all applicable modifiers to ensure maximum specificity and rightful payment.
Here is an overview of telehealth-specific modifiers that you must report:
- Modifier 93: It represents synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system.
- Modifier 95: It highlights synchronous telemedicine service via live, interactive audio and video telecommunications.
- Modifier GT: It is similar to modifier 95, but mostly restricted to institutional claims billed by CAH Method II providers.
- Modifier GQ: It indicates a telehealth service rendered via an asynchronous telecommunications system.
- Modifier FQ: It identifies that the telehealth service was performed as part of a rural health clinic (RHC) or federally qualified health center (FQHC) visit.
That is not all! You must also use the correct place of service (POS) code.
- POS 02: It highlights telehealth services provided other than in the patient’s home.
- POS 10: It indicates a telehealth service rendered in the patient’s home.
Note that improper use of a POS code is a frequent claim denial reason against claims, straining RCM in telehealth clinics.
Patient Eligibility & Verification
Verifying patient insurance eligibility and benefit verification for telehealth encounters is not as simple as it is for in-person visits.
The reason? Patients often book last-minute virtual appointments. Thus, practices risk treating patients whose insurance has lapsed or does not cover virtual-only benefits.
Patient Collection Issues
Ensuring a smooth RCM in digital clinics is significantly harder without a physical checkout process. The outcome? This increases days in accounts receivable and strains cash flow.
Note that clinics without a seamless, integrated patient portal for digital payments experience a high rate of bad debt from virtual visits.
Credentialing Bottlenecks
What happens when your telehealth practice scales geographically? Credentialing becomes an exponential challenge, making RCM in telehealth significantly harder.
Healthcare practitioners are required to get credentialed with insurance carriers in every state where their patients reside. As a result, you must manage 5 to 10 state licenses and the enrollment process per provider.
Best RCM Practices for Telehealth & Digital Clinics
Optimize RCM in digital clinics and telehealth settings by implementing the following best practices:
Leverage Verification Tools
Integrate automated real-time eligibility (RTE) verification tools into your operations for optimized RCM in telehealth settings. This will enable you to verify coverage before the ‘join meeting’ link is sent to the patient.
Here are some key considerations for the RTE software:
- Look for a tool that automatically verifies coverage 24 to 48 hours before the appointment and again at the time of check-in.
- Ensure the system specifically checks for telehealth coverage. The reason? Some plans cover in-person visits but exclude or limit virtual consultations.
Master Telehealth-Specific Coding & Modifiers
Coding errors and modifier misuse are the leading causes of claim denials for virtual visits. Thus, if you want to overcome this challenge, focus on standardization.
Simply put, train your staff on the proper use of telehealth-specific modifiers, such as 93, 95, GT, GQ, and FQ. Also, apply POS 02 and POS 10 per payer guidelines.
Integrate Digital Payments
How can you ensure that patient responsibility (deductibles and copays) is collected seamlessly? By using a secure, HIPAA-compliant payment platform to keep a credit card on file. This will enable automated charging once the claim is adjudicated.
You may also collect required copayments upfront during the digital check-in process, before the provider enters the virtual room, for effective RCM in telehealth settings. This will significantly reduce bad debt and days in accounts receivable.
Eliminate Data Silos
Remember that data silos cause errors in manual data entry, leading to costly denials. Thus, invest in an EHR system that automatically captures start/stop times and the specific platform used. This will also keep your telehealth practice audit ready.
Besides, when your telehealth, EHR, and billing systems are properly integrated, selecting codes within the video platform becomes a breeze.
Focus on Multi-State Credentialing
Avoid marketing your services in a new state until you are credentialed with the major payers in that region. Moreover, you must utilize a central repository, such as the Council for Affordable Quality Healthcare (CAQH) ProView profile, to push provider data to multiple state boards and payers simultaneously.
Monitor Telehealth-Specific KPIs
If you are running a digital clinic, then traditional KPIs may fail to capture the full story. Thus, you should focus on tracking the following KPIs specifically for effective RCM in telehealth clinics:
- Average Patient No-show: Percentage of patients who miss appointments or experience video failures.
- Virtual Wait Time: The time elapsed between a patient’s login and the provider’s joining.
- Patient Satisfaction Score: Conduct surveys to assess ease of use, provider communication, and overall quality of care.
- Cost per Telehealth Visit: The total operating costs divided by the number of visits.
- Total Sessions per Month: Total volume of completed telehealth visits.
- Provider Utilization Rate: The time clinicians spend on virtual visits versus idle time.
- Reimbursement Cycle Time: Time between service delivery and payment.
Why Should Telehealth Practices Outsource RCM Services?
RCM in telehealth settings or digital health clinics can often be overwhelming. However, outsourcing it to professionals like MediBillMD can help you realize the following benefits:
- You save big on the high costs of recruiting, training, and providing benefits for an in-house billing team by outsourcing revenue cycle operations.
- Leading RCM companies manage the rigorous documentation and audit trails needed to safeguard your practice against telehealth-specific audits.
- Specialty-specific RCM firms, like MediBillMD, leverage advanced scrubbing tools. This helps them detect common telehealth errors, such as incorrect POS codes, before claim submission.
- Outsourcing RCM in digital clinics provides immediate access to certified medical coders and billing specialists. These experts stay current on rapidly changing state-by-state parity laws and virtual-only modifiers.
- Third-party RCM partners can easily handle the administrative surge of credentialing and enrollment. This helps your digital clinic expand into new states.
- Moreover, RCM partners use integrated digital front door tools, including automated eligibility checks. As a result, the likelihood of triggering administrative denials reduces significantly.
Partner With MediBillMD
To summarize, optimizing RCM in telehealth settings is key to ensuring timely reimbursement for virtual patient visits.
Hopefully, with this guide as your go-to resource, overcoming telehealth-related challenges will become a breeze. However, if you still struggle, feel free to outsource revenue cycle management services to professionals like MediBillMD.
