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.