Electronic Health Reporter

By Susan Kohler, chief compliance officer, Greenway Health

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law in March, has provided a lifeline for many businesses — including healthcare organizations. Amid the grim reality of medical equipment shortages and limited hospital beds, the CARES Act provides the healthcare industry much-needed relief.

Considering a significant number of practices are struggling to keep their doors open, and hospitals have experienced significant revenue loss from elective procedures being cancelled or postponed, the act has been pivotal in providing critical aid.

However, at over 800 pages, understanding the full impact of the act can be challenging. Below, I’m sharing how the CARES Act can benefit healthcare providers, as well as additional steps medical practices can take today to ensure the financial security of their organizations.

What You Need to Know About the PPP

By now, the Paycheck Protection Program (PPP) has been in place for a few weeks, and many healthcare practices with fewer than 500 employees have likely already submitted their applications. Whether you’ve already applied for the PPP or are weighing your options, here is some need-to-know information to consider.

At its core, the PPP gives businesses an incentive to keep their staff employed. Funds dispersed from this program can be used to cover up to eight weeks of payroll costs and other eligible expenses, such as rent, utilities and mortgage interest. This loan can provide practices with the necessary funds they need to keep their staff employed and continue serving their communities.

While the initial funding for the PPP from the CARES Act quickly ran out, another law passed in April 2020 provided another welcome injection of funding in the program.

The Provider Relief Fund

The CARES Act also set aside an additional $100 billion specifically for the Public Health and Social Services Emergency Fund, managed by the HHS sometimes and referred to as the Provider Relief Fund. These dedicated funds are specifically to help healthcare providers prepare for and support the continued surge of COVID-19 patients.

With COVID-19 having such a huge impact on the whole world, many businesses have struggled and had to either make their staff redundant or even close for trade. Not only are some eligible for help via the CARES act, but there is also a refundable tax credit called Employee Retention Tax Credit where businesses can claim refundable credit on qualified wages, including certain health insurance costs, paid to employees through events such as COVID-19. If you’re eligible for this, you can use an ertc calculator to estimate what you could qualify for.

In order to qualify for payments from this dedicated emergency fund, providers must prove that they are testing, diagnosing or caring for possible COVID-19 patients.

In order to qualify for payments from this dedicated emergency fund, providers must prove that they are testing, diagnosing or caring for possible COVID-19 patients.

Here are a few examples of how these specific HHS funds can be used in a healthcare setting:

• Building or construction of temporary structures.
• Leasing of properties specifically to support coronavirus patients.
• Purchasing medical supplies and equipment, including personal protective equipment (PPE) and testing supplies.
• Increased workforce and trainings for coronavirus safety and education.
• Emergency operation centers.
• Retrofitting facilities to care for infected patients.
• Surge capacity equipment and materials.

 Focus on Revenue Cycle Management Upgrades

The current public health emergency has brought heightened focus to a critical area in healthcare: revenue cycle management. Healthcare providers can no longer afford to wait weeks for payments to be processed as non-COVID related appointments are cancelled or moved to telehealth.

To address this challenge, CMS has expanded the Accelerated and Advance Payment Program to expedite Medicare reimbursements for providers and suppliers who meet certain criteria. This program allows providers to request an amount up to 100% of their Medicare payments from a previous three-month period.

But what about non-Medicare claims? In order to process these, consider adopting a rapid response solution that can help manage critical areas of the revenue cycle, including charge posting, claims submissions and reconciliation, rejection management and payment posting services.

Additionally, work with your revenue cycle partners to gain access to timely industry and billing knowledge to help expedite the process as regulations continue to change.

Telehealth Billing: What You Need to Know

Telehealth quickly went from healthcare’s underutilized misfit to a necessity amongst healthcare practices. At this point, the majority of non-urgent health issues are being addressed virtually, from mental health to GI to primary care and everything in between.

The act of virtually practicing medicine became the go-to method overnight, but many physicians and practices are struggling with coding and billing for telehealth. While there are three main types of virtual services – telehealth visits, virtual check-ins and e-visits – the billing workflow for each type can vary.

It is crucial for practitioners to understand the key differences between each type and how to bill properly in order to quickly receive payment.

Here’s a quick breakdown:

• Telehealth Visits: Both new and established patients can schedule a telehealth appointment. Prior to billing for these services, check the insurance carrier’s website to see if Place of Service (POS) designations have changed, as they are being updated on a regular basis.
• Virtual Check-Ins: As with telehealth visits, virtual check-ins can be made available to both new and established patients. These appointments are often categorized as a follow up or introduction, where a recommendation of care is not necessarily the end goal. A physician or other qualified non-physician provider is required to conduct these appointments in case a recommendation of care is provided, thus turning it into a billable event. Virtual check-ins can also include if a patient submits a video or image for interpretation – if this happens outside of the appointment, it needs to be classified as an asynchronous event. If it happens in real-time or arose from a service performed within the past seven days or within 24 hours of the next available appointment, this service can be billed as synchronous.
• E-Visits: Physicians, physician assistants or nurse practitioners can conduct e-visits with new and established patients. These patient-initiated appointments are conducted in real-time via a secure patient portal. These visits require time-based coding in 10-minute increments and should be submitted within a seven-day timeframe.

Prior to scheduling any virtual appointment, it is recommended that providers obtain written consent in order to protect the practice from any potential issues.

Each day, the healthcare industry faces new challenges with COVID-19. But there are many tools and resources for providers to leverage during this time.

As you continue to navigate this unprecedented situation, lean on your trusted partners to help manage these areas so essential staff – physicians, PAs and other medically trained professionals in your office – can continue to focus their energy on providing quality patient care.