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As the many challenges within virtual care intersect, providers have a unique opportunity to overcome the barriers with a modernized and optimized approach to billing. But there’s one caveat: Modernization does not mean complete automation.
“Until the industry solves its core problem of not having enough providers dedicating their time to telehealth 100% of the time, you’re going to continue to have denials and misdirected claims that you’ll need to deal with,” Baltodano said. “And programmatic solutions can’t solve for that. What you need is an efficient way of having the human intervention to do insurance follow-up, collect on dollar amounts, and respond to disputes and denials within the overarching nuances of these individually negotiated fee schedules.”
Indeed, humans are still — and will always be — a precious resource when it comes to navigating the complexities of the payer-provider reimbursement dynamic. And, Baltodano added, leaning entirely on revenue cycle management (RCM) groups without considering that human skill set can be problematic.
DISCOVER WHERE YOU ARE: Are poor patient experiences in care and billing straining your administrative staff and diminishing ongoing revenue opportunities?
RECOGNIZE THE OBSTACLES: The healthcare industry has not caught up to telehealth demand, and the current revenue cycle management (RCM) process creates complexities within preexisting complexities.
PLAN FOR NEW SERVICE MODELS: The volume of complex tasks in the future will require highly skilled support specialists, an expanded infrastructure, dedicated quality assurance, and periodic compliance training.
EXPLOIT THE OPPORTUNITIES: Strategic investments in BPO partners already well-versed in both the complexities of telehealth and the evolving policy landscape of the care continuum are a strategic advantage.