Checklist for Initiating Recovery of Pre-COVID-19 Deferred or Elective Care
Healthcare providers have never before faced a system-wide cancellation of nonemergent and elective care lasting over several months. The question facing hospitals, providers, and practices now is how and when to reopen and what is the most expeditious way to manage the potential surge of patients that will be seeking care.
Creating an informed, strategic route that looks at clinical, operational, and financial implications coupled with evaluating individual deferred or elective care helps prioritize need and create a path to recapturing those encounters.
UPDATES
- Effective October 28, 2020, Centers for Medicare and Medicaid Services (CMS) issued a rule stating that they will reimburse providers $28.39 for the administration of a single dose of COVID-19 vaccine. If the vaccine turns out to require multiple doses, CMS will pay $16.94 for the initial doses and $28.39 for the last dose of the series. Commercial insurance is expected to follow suit.
- At this point, the federal government is covering the patient cost for the vaccine, but commercial insurance payers are still weighing in on administration costs, etc.
- Effective October 23, 2020, Health and Human Services (HHS) has extended the public health emergency for 90 days or until January 23, 2021. This will also include a new round of $20 billion in support intended to cover ongoing pandemic-related expenses for providers.
| Stage | Checklist |
|---|---|
| Analyze Opening and Evaluate Contingency Plans | Evaluate all available criteria from governmental agencies, health experts, and local authorities to determine when to resume services safely
Enlist social media and community outreach to emphasize safety protocols and measures to patients as well as referring providers as appropriate Bring providers together to prioritize needs and evaluate patient situations Evaluate capacity for each phase of care: pre-determination, procedure/test, post-follow up or recovery, referring provider follow up Assess staffing needs for providers, clinical, and business staff and determine scaling options including considering expanded hours to accommodate the surge in patient needs Create or establish an infectious disease committee to evaluate all aspects of Universal precaution usage to ensure compliance and monitor supplies Initiate COVID-19 testing procedures for all staff members, as well as patients Determine flow to minimize potential contamination of patients and visitors: institute virtual waiting rooms or in-car waiting, reorganize reception and clinical areas to maintain 6-foot social distancing requirements, and create one-way flow throughout the facility Budget financial goals Implement any secondary plans for surges in COVID-19 cases and stay-athome orders |
| Implementing Patient Access Procedures | Obtain prior authorization, verify insurance benefits and collect patient portions due before scheduling
Initiate scheduled pre-appointment consultations through telehealth to minimize personal contact utilizing approved codes for reimbursement Navigate mapped out processes for pre-testing, referring provider consultation, ancillary services coordination Implement extraordinary cleaning measures for patient interaction areas, i.e., reception area, front desk, exam rooms, restrooms, etc. |
| Delivering Care | Ensure separation between COVID-19 patients and non-COVID-19 patients throughout every step
Screen patients for fever and symptoms at check in and provide masks (if not brought by the patient) and hand sanitizer Coordinate sufficient PPE and provider-specific supplies Oversee proper decontamination guidelines are being utilized Allow enough time for adequate documentation post-procedure to ensure precise and timely coding and billing for maximum reimbursement |
| Post-Care and Business Follow-up (Revenue Cycle Management) | Implement telehealth procedures to provide post-procedure follow-up care when appropriate and coordinate ancillary care, including home care, medications, rehabilitation, wound care, etc.
Provide timely follow up to referring providers to maintain relations and increase patient satisfaction Utilize scalable third-party partners to ensure accurate coding and billing, along with AR and denials management Schedule ongoing check-in meetings to stay on top of issues or problems as they arise and allow for redirection or redeployment as necessary |
- Reducing Provider and Patient Burden by Improving Prior Authorization Processes, and Promoting Patients’ Electronic Access to Health Information. Health Informatics and Interoperability Group, Centers for Medicare & Medicaid Services, CMS.gov. January 15, 2021.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Interoperability/index.
Accessed on January 15, 2021. - 2019 CAQH Index, Conducting Electronic Business Transactions: Why Greater Harmonization Across the Industry is Needed. CA QH Explorations. 2020.
https://www.caqh.org/.
Accessed on January 30, 2020. - Siwicki, B. At RadNet, AI-Fueled Prior Authorization Tech Shows Promise. Healthcare IT News, Global Edition, Imaging. May 6, 2019. https://www.healthcareitnews.com/news/radnet-ai-fueled-prior-authorization-tech-99-accurate.
Accessed August 2, 2020. - Ibid. 2.
- Napco’s iBridge Technology Named Top Innovation of 2014 by Security Sales & Integration Magazine – Recurring Revenue Model Makes iBridge a Top Choice for Security Dealers. January 13, 2015.
https://investor.napcosecurity.com/2015-01-13-NAPCOs-iBridge-Technology-Named-Top-Innovation-of-2014-by-Security-Sales-Integration-Magazine.
Accessed on February 3, 2020. - Integrating Prior Authorization Solution with Epic PMS While Protecting PHI at a Pennsylvania Hospital Group. Infinx Case Study. 2018. https://www.infinx.com/resource-casestudy/integrating-preauthorization-solution-with-epic-pms-lt/
Accessed on February 2, 2020. - Diesing, G. A Pathway to Clinical and Administrative Data Integration, Health Data Features. Journal of the American Health Information Management Association (AHIMA). September 8, 2020.
https://journal.ahima.org/a-pathway-to-clinical-and-administrative-data-integration/.
Accessed on September 16, 2020.
About Infinx
Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by artificial intelligence and automation, with our trained and certified prior authorization, coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.