How COVID-19 Has Impacted Patients, Providers, Payers and the Claims Reimbursement Process
COVID-19 has disrupted all aspects of the healthcare system, from patients to providers to payer reimbursements. Patients have postponed or canceled checkups and elective procedures, causing provider revenue to fall. Some of that deficit has been made up through the upsurge of telehealth or telemedicine. This has helped the situation for patients and providers, but payers are still in limbo about how to reimburse for telehealth encounters. Here’s an overview of the impacts of the pandemic on patients and providers, as well as the uncertainties surrounding telehealth and claim reimbursements.
COVID impacts on patients and healthcare providers
It has been a tough year for healthcare providers. COVID-19 has increased the physical, emotional, and financial burden on providers, creating an increase in physician burnout. Healthcare providers have been operating with inadequate supplies and shifting protocols, while risking their lives (and the lives of family members) to care for those infected with the virus.
Providers have experienced financial burdens as well. They’ve had to cancel or postpone many of the procedures and services that keep patients healthy and generate revenue, and they’ve been urged to delay non-emergency or elective medical procedures. They also need to deal with increased costs of personal protective equipment (PPE) and COVID-19 prevention measures. All these issues have had an impact on cash flow for providers and healthcare facilities.
In addition, patients have been reluctant to make office visits out of fear of exposure to COVID-19. This means they are neglecting their care for chronic conditions and postponing their regular checkups, which can have a serious effect on their health going forward. Although many payers say they will waive cost-sharing for COVID-19-related payments, it’s unclear whether the unknown and long-term consequences of the virus will qualify for reimbursement.
COVID-19 impact on payers
Timely testing is crucial for controlling spread of the coronavirus. For this reason, public and private payers have stepped up to alleviate some of the financial stresses laid on patients and providers for testing and vaccinations. The number one priority, of course, is ensuring that patients get the healthcare they need, especially for COVID-19 prevention and treatment.
Several legislative actions seek to help uninsured patients and their providers. It’s important that payers help keep providers informed about the new programs, as well as the need to register for them. Currently, one-third of provider services are eligible for Medicare reimbursements, with some specialties getting 90% eligibility. However, there is a lot of uncertainty about the long-term effects of the disease and what it means for payers. Many patients are experiencing residual effects of the disease, and there are still questions about vaccinations and booster shots going forward.
Another big unknown is telehealth. It has had a surge in popularity, and Medicare is currently paying on parity for telehealth services — but it’s unclear whether that will continue after the pandemic subsides.
What telehealth means for patients, providers, and payers
There are some upsides to the COVID-19 pandemic. Because the virus has disrupted patient visits and in-person healthcare, telehealth has encountered a surge in popularity. Providers have embraced telehealth to minimize health risks and compensate for the loss of in-person health visits and related revenue. Providers can continue to see patients without having to worry about exposing themselves, their staff, and patients to the risks of COVID-19. However, the big unknown is how payer reimbursements will work for long-term COVID effects, which are almost certain to have a major impact on public health going forward.
Telehealth is truly a blessing for patients and providers. The number one priority for the healthcare profession is keeping the population safe and healthy, and payers are onboard with that. How providers, patients, and payers deal with the costs of the pandemic will be a work in progress — and telehealth promises to provide a short-term solution. Whether it proves to be a sustainable long-term solution will depend on how all the parties are able work out the details.
