Nationwide Lockdowns. Economic and Social Disruption. Biggest Healthcare Emergency. Unprecedented Death Tolls. Massive layoffs.
Does this transport you back to 2020-21, when uncertainty became a new normal and lives were affected beyond geographies, races, and socioeconomic status? The governments across the globe enforced lockdowns that forced private sector and institutions to adapt to the new model of working and increased work stress on healthcare institutions, security forces and all the frontline workers to ensure safety and prevent health hazard. As per WHO, as on 5th June 2023, about 6.9 million people have died globally.
Thankfully, positive news has recently come to the fore from the Centers for Disease Control and Prevention (CDC). The federal COVID-19 PHE declaration ended on May 11, 2023. This marks the end of CDC’s authorizations to collect certain types of public health data. And with it, emergency declarations and waivers that were implemented granting flexibility to state Medicaid operations and most healthcare providers have also ceased to exist. Practices, which have relied on these flexibilities over the past few years, now have to look for ways to ensure minimal disruption to their medical billing and operations.
Here is a look at how it would affect healthcare revenue cycle:
I) 50% lesser reimbursement for COVID-19 testing:
The most significant and foremost impact of the PHE ending will be reimbursement cuts for COVID-19 testing. For example, Medicare payments for testing will drop from $100 to $51 per test. Private insurance companies will no longer be required to cover COVID-19 tests without cost sharing. Also, payment amounts set for travel fees and laboratory specimen collection from an isolated homebound or nonhospital inpatient would also end. It will certainly have an impact on the revenue cycle process of practices.
II) Telehealth reimbursement waivers:
Due to COVID-19 induced lockdowns, businesses and public institutions alike had to embrace digitization to conduct day-to-day transactions. In the healthcare sector, these waivers allowed providers to offer telehealth services to patients without prior authorization, and reimbursements for telehealth visits were increased. However, now that the PHE has ended, this service may also cease to exist, affecting the revenue cycle process and most importantly, patient experience.
Additionally, the Centers for Medicare & Medicaid Services (CMS) removed four CPT telehealth service codes (96121, 99221, 99222, 99223) from the approved list. As a provider, you should take notice of these changes to stay updated and adjust medical billing practices accordingly.
III) Waivers for Medicare coinsurance and deductible payments:
During the pandemic, Medicare waived Part B coinsurance and deductible payments for COVID-19 treatment. Due to this offer, Medicaid enrollment increased significantly, and over 91 million people were enrolled as of October 2022. But with these waivers ending, the healthcare providers may have to bill patients for the coinsurance and deductible payments, which could increase the efforts and time for billing for the services provided, increasing the A/R days in the healthcare revenue cycle and impacting patient financial experience.
Furthermore, COVID-19 also suspended the 2 per cent Medicare sequestration, which was a reduction in Medicare payments to hospitals. With the end of the PHE, this sequestration may resume, reducing Medicare payments to hospitals, thereby affecting the total cost collected.
Stay ahead of challenges and minimize healthcare revenue cycle disruptions
Providers can minimize the potential negative impact on their bottom line by being proactive and understanding the new changes and implications of reimbursement policies. Firstly, as a provider, it’s critical to review all available PHE guidance from sources like CMS and your local Health and Human Service Administration (HHS). Another essential way to minimize revenue disruption to your revenue cycle process is by ensuring patient eligibility. Automated, real-time eligibility checks are critical to helping mitigate denials and optimize revenue capture.
Jindal Healthcare’s HealthX 2.0, an AI-based solution, is updated with the recent guidelines and as per policies, using which our experts can streamline your healthcare revenue cycle — helping you streamline eligibility and identify patient insurance easily and efficiently, prevent denials, and accelerate reimbursements. Want to know more about HealthX and what it can deliver for your business? Book a Demo.