It’s well known that coding changes drive provider behavior, and billing behavior drives provider decisions.
For the last 30 years, little has changed in health insurance billing, which is why the standard of care within the payer system has remained, well, standard.
Then the pandemic hit, and suddenly everything was turned on its head. Patient demands increased sharply, office visits became impossible or prohibited across most of the country, and with telemedicine, the standard insurance codes for billing were no longer sufficient. Thus, a whole new learning curve was required to bill for remote patient care.
COVID has exposed our weakness in managing lifestyle-driven diseases and comorbidities.
Chronic disease and comorbidities have been on the rise for decades, and there is ample evidence that the majority of them are lifestyle-driven.
The lifestyle factors, like chronic stress, poor diet, lack of movement, etc., that lead to compromised immunity and comorbidities now make patients too vulnerable, even if they’re on medication. Suddenly, a person’s lifestyle choices can mean the difference between life and death.
Patients realize this, which is why they’re seeking more care options and advice from their providers.
In other words: The days of prescribing medication and just hoping your patients will make a few lifestyle changes are gone. People need more direction, follow-up, and tracking. This means the modern physician is now charged with providing adequate resources to accomplish this while re-learning how to get paid for a higher level of care.
How do we do more with less?
It’s time to make the system work for you.
This means you as a provider can leverage your time, your team, and your outsourcing capabilities to grow your practice and improve patient outcomes in ways that weren’t possible pre-pandemic. And yes, it’s all billable, thanks to 2021/2022 CPT coding changes.
Here are five proven methods of how to do more with less:
Telehealth makes medicine more accessible and convenient to patients while streamlining provider time and resources. Moreover, patients are demanding it.
According to findings from McKinzey and Company: “Telehealth utilization has stabilized at levels 38X higher than before the pandemic.”
And a Harris Poll completed on behalf of NextGen Healthcare found “an overwhelming majority of U.S. patients who received telehealth services since March 2020 (84%) plan to continue using telehealth appointments in the future, citing reasons such as convenience (43%) or to avoid being around people who are ill (39%).” 57% said they would be more likely to get follow-up care if telehealth appointments were an option.
So this medium of care isn’t going away and is anticipated to expand. This is reflected in the aforementioned statistics and the trends in coding changes we’ll discuss in the next sections.
When it comes to billing, the coding rules have changed from direct supervision to general supervision. This allows clinical support staff such as PAs, NPs and health coaches to get involved and provide the majority of reimbursable/billable patient services via telemedicine, even if the lead physician is not in the same building.
2. Health coaches
Studies have proven that certified health coaches can significantly help patients implement behavioral changes to improve (or even reverse) chronic disease. However, without an NPI number, health coaches didn’t qualify as billable practitioners — until 2021.
Thanks to impressive lobbying efforts and pandemic pressure, board-certified health coaches now qualify for their own taxonomy number.
The bottom line: now that health coaches are officially considered “providers” and the coding rules have changed to “general supervision,” doctors have more options for outsourcing various aspects of patient care.
We’ll explain more about how this works in terms of billing/CPT codes for health coaching in Part 2 of this article.
3. Breakout rooms for physician consults
Under the “general supervision” guidelines, doctors can hand off most aspects of patient care to other providers so long as they are available by phone to answer questions.
In the virtual group visit model, breakout rooms serve these purposes. They allow the practitioner to spend a few minutes assessing each patient’s status, adherence, and progress, then hand them back to their support practitioner/health coach. The health coach leads an education and support program for a chronic disease group (i.e., type 2 diabetes), then each participant has a quick breakout session with their primary care provider.
4. Taking full advantage of new 2021 CPT codes
The last 30 years of coding have been based on two things: Time and severity and leaned on counting elements for history and exam as one of the driving factors for code selection. Now, many aspects of patient care can be billed based on either time or Medical Decision Making (MDM). For example, with the MDM matrix, whether you spend 5 minutes or 200 minutes with a patient, it qualifies for reimbursement as long as you cover two out of three requirements.
To quote Dr. Cheng Ruan, internist, regenerative medicine specialist and pandemic-made expert in telemedicine CPT codes, “We blend the general supervision and taxonomy codes and use those to work for us.”
Dr. Ruan’s practice went from 5% telemedicine visits pre-pandemic to over 86% telemedicine visits. In addition to running his expanded practice, he now helps other providers learn to adapt to this new remote model of value-based care.
5. Group visits supervised by physicians, led by health coaches and support providers
Conducting remote group medical visits led by health coaches with the physician in a breakout room allows for a higher quality chronic disease prevention and management and better patient outcomes.
Using this model, a doctor can see a dozen or more patients in a 75-minute window versus just a few. Plus, when you set up programs for specific chronic disease management, you see the patients monthly and bill them monthly with less time and effort.
Increasing efficiency, positive patient outcomes and the bottom line is how we make the system work for us and do more with less.
James Maskell is a health care executive.
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