The healthcare system has suffered a lot due to the ongoing COVID-19 pandemic. However, the pandemic also transformed the current working of the health system and directed towards a way in which they can improve their ability to tackle the upcoming challenges.
Telehealth services are one of the positive outcomes of this pandemic. The mandatory social distancing during the peak of the covid-19 pandemic makes it difficult for the patient and the physician to plan an interactive session.
At that time telehealth services are the only way to have a safer interaction between the patient and the physician.
Whether it is traditional or telehealth the denial rates have always been a problem for the health care service provider as it significantly reduces the revenues which impact their ongoing operations.
Ways To Reduce Telehealth Denials
In this article, we will explore some ways in which you can reduce the telehealth denials and get maximum revenues.
Check the Coverage
Before starting the treatment you need to check the insurance coverage of the patient. The private insurance company offers coverage for telehealth services but it also depends on their policies.
Because it depends on the policy by the insurance companies then it is essential to verify insurance coverage by calling the payer.
Moreover, the requirement to document a visit also varies. So again the best way to check the coverage and documentation of the visit is to call the service provider and ask for the complete details.
Fulfill the Clinical Documentation
Proper clinical documentation is essential to get the reimbursement for that purpose you practice needs to fulfill all the gaps.
If there are some gaps in the clinical documentation like improper information and any error in the coding then it can lead to a claim denial so make sure that you check all the documents before submitting it.
Proper Training of Your Staff
It is essential to give your staff proper training especially on documentation which is the foundation of any billing process. The staff should be aware of the following process:
Like verbal consent before making an appointment.
And to make sure that what kind of communication medium is used for the interaction, like it can be a video call or an audio call.
They should also note the total length of the meeting when it started and when it ended and what was the purpose of the meeting.
Moreover, the location of the patient and the service provider at the time of interaction should also be noted, and which platform they used during communication. All these details will help your staff member to document the whole meeting appropriately.
Use Appropriate Coding
Coding is one of the main reasons behind the higher denial rates not only for traditional medical billing but also for telehealth claims.
The requirements for the telehealth services coding and billing varies and most of the time the billing staff was not aware of the requirements and regulations issued by the insurance companies. And this was one of the biggest reasons behind the higher denial rates.
To minimize the coding errors the health service provider should:
- Provide proper training to the coding staff to manage the payer requirements and take a deep look at the proper coding of telehealth services and be aware of the latest regulations and trends.
- Educate your staff members about the coding guidelines specifically related to covid-19.
- A proper sequence of diagnosis and treatment should also manage as it is part of appropriate coding.
Clean Claim Submission
Before submitting the claim make sure that all the essential documentation is correct and there is no error in coding. Make sure to submit the claim on time as the insurance companies only process those claims that are submitted timely.
Track Denial Rates
Make sure that your practice is consistently tracking the denial rates. For most health care systems denial rates are normal but frequent denial rates are the indication that something is wrong in the system and a proper investigation is required.
After the proper assessment of the issue, the follow-up team can provide the proper documentation and make the case to get reimbursement.
Covid-19 is completely changing the operating system of health care industries. While the adoption of telehealth services is not easy at first instance, challenges are part of the advent of any new system. Who knows that in the coming day’s people prefer to get regular check-ups at the comfort of their homes.
Throughout the article, we discussed how higher denial rates can cause serious damages to your revenues and how you can avoid it to get maximum reimbursement.
Apart from these tips, you can also outsource your billing activity to a professional billing solution company as they have a highly skilled team that manages many other health services providers’ RCM.
Med-Miles is one of the top billing solution companies. We have been serving the healthcare industry for almost eight years. We are focused on learning and implementing the latest ideas to achieve the best results for our clients. Call us at (888) 598-9181 for more information.