As the coronavirus (COVID-19) continues to grip headlines from coast to coast, the Centers for Medicare & Medicaid Services and the U.S. government are working to assist state and local agencies and providers with combating the infection. In addition to the recent $8.3 billion spending bill passed by Congress, CMS developed new billing codes which will better equip clinical laboratories and other providers to bill for lab tests, supporting testing and tracking of new cases and telemedicine initiatives. As additional regulations to better accommodate patients and providers evolve every day, it’s imperative to stay updated on best practices and resources, as well as to follow governmental and industry moves. Below are a few recent examples of important updates:
- CMS released COVID-19 recommendations to postpone elective surgeries and non-essential procedures – especially non-emergency dental procedures – to conserve critical resources and reduce exposure among patients and providers.
- Medical Group Management Association (MGMA) urged Congress to provide direct financial assistance to group practices, as these practices and clinicians on the front lines of the COVID-19 public health crisis need prompt congressional action to continue treating their patients.
- MGMA joined the coalition calling on the House and Senate to ensure access to Medicare value-based care.
- MGMA joined the coalition calling on CMS to allow flexibilities for Quality Payment Program-participating clinicians to ensure COVID-19 does not derail the Alternative Payment Model (APM) and value movement.
Even with these measures, health practices across the U.S. still need to take a step back and ensure their internal processes and administrative workflows are prepared for the coming weeks and months. By quickly reviewing and planning at a fundamental level, practices will be better prepared to address any challenges that COVID-19 presents. Here are five ways providers should begin to prepare:
1. Enact Practical Business Continuity Plans
First and foremost, it is important for leaders to address their business continuity plan immediately. As health care providers have had – and will continue to have – direct contact with patients experiencing symptoms, it’s important that the proper steps are taken to limit and protect other patients and themselves from exposure. Additionally, it’s critical to ensure they will consistently have the support staff necessary to carry out operations as normal, including patient care, administrative needs and reimbursement practices. In this case, it’s important to ensure employees are adequately cross-trained, because when employees contract the virus and are unable to work, practices must be able to quickly fill skill gaps. It will also be necessary to ensure security measures and data protection efforts are intact. As claims and tensions are high, health care providers become more vulnerable to malware attacks, and the COVID-19 pandemic isn’t exempt to this unfortunate threat.
2. Ensure Vendor and Third-Party Partner Support
As providers are evaluating their own business continuity plans, they will also want to make sure essential vendors and third-party partners have the infrastructure in place to address areas of concern in the coming weeks and even months. Stakeholders key to maintaining a practice’s operations include medical suppliers (with the ability to provide gloves, masks and other essential medical equipment), systems providers, revenue cycle partners and insurance carriers.
3. Optimize Administrative and Central Office Processes
Streamlining administrative procedures such as pre-visit and post-care billing processes can also help health care providers reduce further contamination. By having patients fill out required administration forms prior to their appointments and utilizing patient portals for payment instead of in-person transactions, practices can increase operating efficiency and reduce potential spread of the infection.
4. Expand Telehealth Utilization
By utilizing telehealth, providers can expand access to care as it could be challenging for patients to seek in-person care during this time. Telemedicine provides a community health service for vulnerable populations as well as people who may already have symptoms to prevent additional and unnecessary spread of the infection. Major insurance carriers announced that due to COVID-19 (and for a restricted time period), health care providers can use telehealth services to treat COVID-19 and for other medically reasonable purposes from offices, hospitals and places of residence (like homes, nursing homes, and assisted living facilities) and be reimbursed at standard office visit rates. Effective in early March and for the duration of the COVID-19 pandemic, CMS also enacted the following as it relates to telehealth:
· Waived geographic restrictions, which will assist patients with receiving telehealth services in non-rural areas.
· Waived site restrictions, allowing patients to receive telehealth services from their homes.
· Allowed use of telephones with audio and video capabilities.
· Allowed reimbursement for any telehealth covered code, even if unrelated to COVID-19 diagnosis, screening or treatment.
· Lifted the established relationship requirement, which expands access to patients that haven’t seen a provider within the last three years.
5. Readjust Revenue and Cashflow Forecasts
Providers will need to adjust their revenue and cashflow forecasts and prepare accordingly to weather the uncertainties during this crisis. They may also wish to apply for line of credit with their financial institution or apply for an SBA loan that the government is offering to ensure they have cash to operate.
Regardless of the type of specialty, patients are going to be concerned about visiting offices, which is going to lower patient volumes and revenue. In addition, the following may impact cashflow:
· Lower number of elective procedures due to the restrictions from hospitals and CMS mandates.
· Lower and delayed payments from insurance companies and third-party administrators (TPAs) due to lack of resources to adjudicate claims on a timely basis, especially if submitting paper claims with supporting documents or appeals.
· State or city mandates to lock down cities that will restrict anyone from travelling.
· Lack of resources in the revenue cycle team to process claims.
By taking critical, preparative steps now, providers can ensure they’re equipped for the uncertainties likely associated with the coronavirus. Being able to continue business as usual by minimizing disruptions will alleviate the straining of health care resources and provide those that need care the necessary assistance to obtain it.
Mel Gunawardena is managing partner of SYNERGEN Health LLC.