Telehealth & Prior Authorization
The world continues to fight against the COVID-19 pandemic on multiple fronts, but perhaps most affected is the practice of medicine. Lockdowns, quarantines, and other travel restrictions have helped to spur massive growth in telehealth. Prior to the pandemic, telehealth claims grew 53% in one year, says the AMA; faster than any other sector. Consultants at Frost & Sullivan reported 50% growth in telehealth visits in March 2020, and some analysts predict that interactions will surpass 1 billion by the end of the year. This means that the growth of telemedicine visits — and the challenges presented by telehealth and prior authorization — are on the horizon for practices across the nation and the world.
Telehealth During The Pandemic
In response to the necessity of telehealth as a broad spectrum of services, the U.S. government reacted by relaxing regulations. The declaration of a national emergency included temporary changes to healthcare laws and requirements such as those under Medicaid, Medicare, and HIPAA.
Much of this relaxed regulation has impacted the delivery of telehealth services in a positive way. More providers are now able to utilize telehealth than before, allowing them to offer care to patients who are quarantined, or concerned about an in-person visit. Providers are now able to be reimbursed for a wider range of “virtual care” scenarios, including telehealth services over applications like Skype or Zoom, chat applications, and phone calls.
However, these relaxed regulations won’t be sticking around forever. The temporary changes are meant to ensure that medical providers are reimbursed during a period of dramatically increased use of telemedicine. Experts believe that reimbursement for telemedicine visits and telehealth overall will continue to increase as adoption increases. More patients are expected to continue using telehealth services after the pandemic, having established digital relationships with providers and enjoying the convenience of virtual health care. Providers and insurers benefit from telemedicine, too; when used for milder cases or for non-urgent care, telehealth plays a vital role in reducing the impact on doctors and emergency rooms.
The Challenges Of Telehealth
Telehealth and telemedicine visits are here to stay, but this rapid change comes with challenges.
Providers have been required to quickly adapt their practices to include telehealth. This often involves new technology solutions such as telehealth platforms offering video and chat services. Shifting technology means that integration with other practice tracking, software, and documentation becomes a crucial task — often assisted by implementation of EDI solutions.
Volume is also a concern. Healthcare providers and payors alike are dealing with rapidly increasing volumes of telemedicine visits for workers’ comp claims and other medical care as well as in-person visits. Many who were putting off healthcare during lockdowns are now seeking it, and this is creating a new healthcare crisis of its own — with an influx of new COVID-19 cases and non-emergency cases alike.
Perhaps the most common question asked by both patients and providers, though, is whether they will be reimbursed for telemedicine visits.
The Future Of Telehealth And Prior Authorization
While the answer is clearer at present due to relaxed regulations, the future of telehealth and prior authorization is not as well-defined. Currently, some insurance companies embrace the practice of telemedicine and have specific reimbursement policies while others do not. Some U.S. states have telehealth parity laws. which require payors to reimburse services at the same rate as for in-person visits — while others, again, do not.
One must also consider the difficulties posed during periods of rapid adoption of new technology, combined with an influx of new cases, when it comes to expediting claims and reimbursement. Prior to the pandemic, 1 in 4 practicing doctors stated in an AMA survey that difficulties handling prior authorization led to a negative impact; sometimes, these impacts were permanent damage to, or even the death of, the patient in care. Furthermore, a study done by the AMA in 2019 (released in June 2020) cites some alarming statistics:
29% of physicians polled reported waiting at least 3 business days for prior auth responses
91% of physicians polled reported delays in care caused by prior auth challenges
90% of physicians polled reported a negative impact on care caused by prior authorization
Prepare For The Telehealth Revolution
The communication between payors and providers must be as efficient as possible to overcome these difficulties. It’s clear that prior authorization presents a major challenge to all parties involved in medical care and workers’ comp claims. The significant adoption of telehealth only causes this to grow in importance for practices across the country.
Swiftivity’s EDI-powered solution for healthcare prior authorization requests is equipped to help providers and payors — including those handling workers’ compensation claims — navigate these challenges. Streamlining the RFA process can reduce harm to patients caused by delays in prior auth, handle the increased volume of claims more efficiently by improving and speeding up communication, and improve overall revenue cycles during the telehealth revolution.
