Post-COVID Era Brings New Challenges and Opportunities for Getting Paid

After a year of unprecedented impact, independent healthcare practices are emerging from the pandemic with great potential for growth. According to recent surveys conducted by Kareo, more than 50% of respondents ended 2020 with their patient volumes the same or even higher than they had been in 2019.

Despite the uncertainty and volatility these practices faced, they demonstrated tremendous resilience and optimism for the future.

A change in regulations is one of the ways independent practices have been able to not only survive but thrive in a post COVID-19 world. As you move through the rest of 2021, it’s critical as an independent practice to keep track of evolving policies, because they ultimately impact your bottom line.

A recent article in Physicians Practice by Terri Joy, Kareo’s billing subject matter expert and Aimee Heckman, a business consultant, examines these changes and what practices need to understand to maintain their revenue cycle. The article, “Getting Paid Today: Challenges and Opportunities for Independent Practices,” is the second in a two-part series on getting paid.

The article addresses other new legislative changes and patient requirements, including new E/M coding guidelines, patient remote monitoring and surprise billing legislation. Highlights include:


New E/M Office and Outpatient Coding Guidelines


New guidelines have recently come out for office and outpatient visit evaluation and management (E/M) codes that now allow you to be compensated for time spent in activities related to patient care, which were not previously accounted for in the coding guidelines. The previous guidelines required that 50% or greater of a patient visit be spent on counseling and coordination of care, but the new guidelines have now expanded to include total time you spend that is related to the visit.

This time can now include non-face-to-face time spent on the day of the visit performing such as activities as reviewing tests, obtaining or reviewing patient history, performing exams or evaluations, counseling and education of the patient, family or caregiver, and ordering medications, tests or procedures.

In addition, the new E/M guidelines provide for billing codes for new levels of medical decision-making based on new criteria.


New Remote Monitoring and Surprise Billing Opportunities


Advanced remote monitoring technologies can allow patients with chronic conditions to stay on track with their treatment plans and improve overall outcomes. You can implement these technologies to increase patient adherence to care plans and better monitor a patient’s condition to quickly and easily identify when changes might require an in-person visit or adjustment to medications.

In addition, new legislation on surprise billing has recently passed that will prohibit providers from billing for out-of-pocket expenses that a patient could not have reasonably predicted.

While this primarily impacts hospitals, it’s important for you to review the requirements and both federal and state laws to determine how it may impact your practice. As a range of new legislation is enacted, independent practices have both new opportunities to increase the bottom line and new pitfalls to avoid.

You can read the complete article in Physician’s Practice here to better understand how these new regulations and developments will impact your independent practice and how you can ensure you are properly following all procedures to maximize your revenue opportunities and improve patient care.

To find out how Kareo can help you maximize your patient collections, visit us here

About the Author

Cher Knebel is a Sr. Content Marketing Manager at Kareo and joined the company in 2019. She has been a content creator for more than two decades, specifically working...

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