This is How Telehealth Will Impact Your Organization’s Revenue Cycle

Telehealth is changing the healthcare landscape and has evolved dramatically in the past year and a half. It’s impacting workflow, policy, research, and revenue cycles. That’s why your organization needs to devise a long-term game plan for your revenue cycle related to this care model for the services beyond the Public Health Emergency (PHE) and in the event of additional waves of COVID-19, which we are seeing now across the country. Telehealth is here to stay, and it’s only going to be utilized more in the foreseeable future.

Healthcare organizations universally reported that COVID-19 had a negative financial impact due to decreased revenue and decreased patient volumes. And just when we thought we were over the hill in many parts of the country, healthcare organizations are canceling or postponing elective surgeries again. Tighter restrictions are coming back.

One of the silver linings of the PHE was the rapid adoption of telehealth. Telehealth gave many organizations an income source when revenue was significantly reduced. CMS further eased the burden by temporarily adjusting billing requirements, making it easier to comply and bill for these services. According to the Medical Group Management Association (MGMA), some hospital-affiliated practices have no-show rates as high as 50%, and even the best-run practices experience at least a 12% daily no-show rate. Another unexpected silver lining of the PHE, through the expansion of telehealth, is that no-show rates have been drastically reduced, particularly among behavioral health patients and the Medicare and Medicaid population. These demographics are most susceptible to experiencing social determinants that are barriers to either receiving healthcare or complying with treatment recommendations. No-shows and missed appointments decrease compliance, often leading to more costly healthcare needs, so it is advantageous for the no-shows and cancellation rates to drop. For example, the psychiatry service no-show rates pre-COVID-19 were between 19 and 22%. Some organizations report improved no-show rates for these services down to anywhere between 4 and 10%.

Where can you focus your revenue cycle efforts, and what areas need adjusted workflows? Let’s look at some of the critical revenue cycle components and how telehealth services have affected them.

Updated Demographic Information and Current Signatures on 
Consent Forms

In your average outpatient setting for an in-person visit, someone greets the patient and validates current demographic information on file, ensures the insurance information is accurate for billing, scans the new insurance card, and updates signatures on forms for compliance. Patient check-in is a crucial step of the revenue cycle. How will this information be obtained in a telehealth setting without it being burdensome administratively?

With so much fluctuation in the job market and employment status, along with changes in guidelines for coverage of telehealth services, it is imperative to perform your eligibility and benefit checks. When you have regular sources of revenue and money is flowing routinely, small gaps in revenue cycle procedures are less noticeable, but these small gaps can quickly become gaping holes under the current circumstances. It’s strongly encouraged not to skip eligibility checks.

Collection of copays/deductible/coinsurance and even balances? Some organizations are still waiving cost-sharing since we are still in the PHE, but that won’t always happen. Time of service collection is crucial in AR management and not letting patient AR get out of control. What is your game plan for collecting the patient portion?

Accurate Coding

Despite the ease in billing requirements, we have seen systemic misapplication or misinterpretation of the guidelines. We’ve seen inaccurate coding for E/M outpatient visits when the telehealth service was audio-only. If you refer to CMS’ list of approved telehealth services, a column will delineate whether Audio only satisfies the code requirement. Moving forward, consider how to identify in-person from telehealth visits, online digital E/M, etc., proper documentation in the medical record of consent, location, type of visit, and media used to ensure accurate coding and, of course, what services it is imperative to keep up to date on what services are approved for telehealth services with payors.

AR Management is critical under all circumstances to ensure profitability. Now more than ever, both timely insurance and patient collections should be a key priority, as well as stringent denial management procedures.

Tools to Adjust Revenue Cycle

What tools can you implement to ensure a high-performing revenue cycle, and how do you need to adjust procedures? Focusing on the areas of the revenue cycle that we anticipate will be significantly affected by telehealth services, let’s talk about what tools we can implement to navigate the impact.

STEP 1:

Implement a real-time, interactive verification of demographic information. Either as part of the telehealth appointment or before the appointment.

STEP 2:

Automate paper-based processes, that includes functionality for forms 
before appointments.

STEP 3:

Instruct the patients to take a photo of the front and back of their insurance card and provide them with instructions on sending encrypted, secure PHI in an email or through a patient portal.

STEP 4:


Most organizations already have a benefit and eligibility solution; it needs to be used consistently. If you don’t have an online payment option, this will be very important in the long-term management of telehealth patients.

STEP 5:

Integrate patient scheduling into the existing management system.

Alternatively, there is software available that has several of these features built-in, such as a virtual check-in room to greet the patient by a staff member who will validate their information, a copay collection option so patients can pay within the program, patient portals built-in so documents can be sent back and forth. Whichever tools you decide to implement, consistency is vital.

Stay tuned for part 4 of this 4-Part series, “How to Mitigate Risks.”

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