As the results roll in, one thing is certain—COVID-19 has had a devastating effect on many physicians’ livelihoods and outpatient care throughout 2020 and into 2021.  Unless directly engaged in the fight against COVID-19 (i.e., emergency rooms, hospitals, testing facilities), traditional care modalities have swiftly gravitated towards telehealth options. Also, the number of patients seeking care has dropped dramatically, particularly in high-risk populations—children and the elderly—and will likely stay low until more vaccines have been distributed.  

According to a recent study done by Harvard University and reported by the Commonwealth Fund, Outpatient in-person care has declined by as much as 60% while telehealth visits have exploded.  Particularly hard hit are specialty practices that provide elective or non-emergent surgical care or on-site testing necessary for diagnosing and creating treatment plans. And with a second and third wave of COVID-19, elective surgeries and on-site testing continue to suffer with patients further postponing needed treatment.

The Financial Impact on Ambulatory and Outpatient Practices

With patient volume collapsing, physician practices and outpatient facilities are experiencing unprecedented financial challenges with practice revenue decreasing by over 55%, according to a survey just released by the Medical Group Management Association (MGMA).  According to a new survey cited by the American Medical Association (AMA), 75% of physicians are using telemedicine which has turned out to be a bright spot in an otherwise bleak year.

What Does the Future Hold?

As the nationwide vaccine program continues, there is bound to be a surge of patients seeking care when our full society reengages. Until then, there will be challenges to stay viable.  From the current information available, we can anticipate a severely under-prepared and under-staffed medical community poised to respond.

Let’s look at some ways that advanced automation and third-party support could benefit practices through this unprecedented time as well as provide scalable solutions as patient volume begins to grow.

Patients Reengaging for Deferred Elective Procedures and Practice Visits

In anticipation of a large number of patients that will be seeking care and requiring elective or non-emergent procedures, consider fully automated and integrated patient access tools available to reduce administrative friction and quickly distill patient logistics:

  • Insurance Verification — Automated insurance verification and benefits eligibility fully supports the reimbursement process and allows practices to collect the estimated money due before the visit.  Many practices still rely on a manual administrative workflow that bogs down the patient access process and too often is left undone.
  • Prior Authorization — Real-time prior authorizations can be achieved through artificial intelligence (AI) driven software that automatically determines necessity, collects required demographic and care information, and submits fully prepared prior authorizations to the correct insurance payer with little if any, administrative support.

Coding and Billing Support Through the Gap

Whether scalability is a problem or just staying current and up-to-date on the COVID-19 changes to coding and billing through Medicare, Medicaid, or the commercial carriers, consider engaging a third-party partner on either a temporary basis (to weather the COVID-19 storm) or as part of a long-term strategy.  Available expert support lessens the practice burden while maintaining a strong reimbursement program when most needed.

AR Optimization and Uncompensated Care

An immediate proposition to strengthen the bottom line, third-party support to optimize current ARs finds money owed, but not yet collected.  In addition, using a fully automated and AI-driven insurance discovery tool finds undisclosed or unknown coverage for patient care that is in peril of becoming bad debt and written off as uncollectible.

Currently unknown, we are facing an uncertain future where the fiscal impact on physicians and outpatient care facilities will be felt for years.  However, there are constants that don’t change:  1) our population is living longer and will require more care in the future, 2) the third-party payer system is ongoing, and insurance providers will continue to require prior authorizations and accurate billing information to reimburse providers, and 3) the industry will continue to move forward.

Contact us to discuss how Infinx can support your continued efforts to weather the COVID-19 storm.