Healthcare overpayment prevention may not be an issue the average layman thinks about when considering advancements made in the healthcare field during the COVID-19 pandemic. However, professionals in the field know accurate healthcare billing and coding is crucial for patients to receive timely care and providers to have the resources they need. Having a plan to prevent and recover overpayments is only one example of the many lessons learned during the COVID-19 public health crisis.
Almost every aspect of our society and economy has seen evolution and/or disruption from the COVID-19 pandemic, but none more so than healthcare. Unprecedented challenges have forced providers and payers to adapt in treatment, research, and even administration. The crucible of the pandemic has exposed shortcomings in our current system, but also encouraged advancement and evolution throughout the system.
Let’s look at some of the healthcare changes formed in the crucible of the COVID-19 pandemic.
In March 2020, at the beginning of the pandemic, only 19.5% of Americans had completed a telehealth appointment. A year later, 61.1% of Americans had completed a telehealth appointment. Many providers only launched telehealth as a response to the challenges of providing routine healthcare during the COVID lockdowns, but most experts believe this mode of healthcare delivery is here to stay.
Telehealth has the potential to expand healthcare access to underserved populations that may not have the same transportation access. It reduces overhead because of a lower need for exam rooms or support staff and can even allow providers to expand their hours and, thus, their billable time. Most importantly, it increases customer satisfaction: 87.8% of patients want to continue using telehealth after the pandemic.
Check-Ins and Patient Visits
COVID-19 forced providers to rethink the patient experience in order to comply with social distancing. Changing the flow of patients through check-in and waiting rooms might have been a low priority without the impetus of the pandemic, but it still provided lasting improvements for many practices.
For example, many medical providers implemented digital check-in procedures to minimize face-to-face interactions. This reduced or eliminated lines and made things more convenient as well as safer. Providers also rearranged appointment schedules to minimize wait times and adjusted waiting room layouts and furniture.
Medical Billing Errors and Cash Flow
The pandemic led to a drop in patient volume. Many providers used the extra time to reduce billing errors, recover missed payments, and shore up their cash flow. Providers reviewed denied claims, such as Medicare and Medicaid claims, for inaccuracies or clerical errors. While some claims were beyond the timeframe to collect, these reviews allowed practices to recover some revenue, and identified errors and poor practices for better accuracy in the future.
Even as patient volume returned to normal levels, practices used these reviews to improve accuracy. It’s estimated that 80% of claims feature at least one error. Improving accuracy allows practices to recover more of their revenue going forward.
Healthcare Overpayment Prevention
The COVID-19 pandemic was challenging for healthcare payers, such as employer-provided or private health insurance. Insurance is a field predicated on accurate risk forecasting and assessment. The advent of the pandemic caused unexpected costs, shifts in cash flow, and volatility in all areas of healthcare payer operations.
Fraud, waste, and abuse costs were a challenge for healthcare payers even prior to the pandemic, costing an estimated $300 billion each year. COVID-19 exacerbated these challenges due to a proliferation of new codes and new coding protocols. With overbilling appearing on as many as 80% of claims and totaling an estimated 3–15% of healthcare expenses, the volatility of the pandemic has brought renewed importance to payment integrity for healthcare payers.
The complexity of healthcare billing and coding has airways made it difficult to catch more than a small percentage of overpayments. Healthcare payers have learned that a trusted payment integrity partner is the best way to get control of these costs and protect their bottom line. Alaffia Health, for example, leverages an advanced AI-driven platform to identify high-cost claims with high probabilities of error and request supporting documentation. This platform enables Alaffia’s experienced, expert team of medical billing and coding experts to ferret out and recover overpayments. In many cases, they work fast enough to prevent the overpayment in the first place.
By cutting down on overpayments and waste, healthcare payers preserved the resources to weather the COVID-19 pandemic and provide better care at lower cost for their members going forward.
Coronavirus as Catalyst: Healthcare Billing and Other Lessons Learned
Any time of great change is also a time of great opportunity, and it’s hard to imagine a time of greater change for the healthcare sector than 2020 and 2021. From payment integrity to patient experience, the lessons learned during the pandemic will pay dividends as society settles into its new normal. Best of all, many of these lessons aren’t difficult to implement.
Healthcare overpayment prevention, for example, can be accomplished by simply finding the right partner. Alaffia Health can integrate their systems into yours and begin preventing and recovering overpayments right away. Their methods save healthcare payers an estimated $150 per member per year. That’s an immediate difference to the bottom line.
As the healthcare sector emerges from the crucible of the pandemic years, successful organizations will apply the hard-won lessons learned during COVID-19. Choosing the right partners makes it easy to apply those lessons. Book a call with Alaffia Health to revolutionize your healthcare overpayment prevention for better care and lower member costs.