For many providers, due to the rapidly decreasing number of patients going to their offices, the business side of their practices has been plunging thanks to COVID-19. Many providers became eager to collect telehealth revenue in light of the drop in patient volume. Due to COVID-19 effects and warning signs, patients and providers alike are resorting to telemedicine without a protocol for reimbursement. As telemedicine becomes mainstream, the cost of the appointments as well as the reimbursement to the doctors remains a mess. Insurers are unclear what to reimburse, and until just recently CMS was spotty in covering telemedicine visits.

While many telemedicine patients are being charged up front, CMS recently stepped out to issue guidelines for telehealth reimbursement. The new CMS guidelines boosted rates for telemedicine visits to match the CMS payment for an in-office visit. Yet, many patients pay for their telemedicine visit up front in light of the political edict to ensure patients have no out of pocket costs for using telemedicine. Some providers are waiving the patient out of pocket for in-network doctors while some are charging patients up to $200 up front for a single telemedicine visit. The Wall Street Journal reported CMS telehealth visits rose from 100,000 a week before COVID-19 to 300,000 per week, while expecting a continued increase in patients moving to telemedicine.

FairCodeincreases clean claim ratios by combining the domain expertise of experienced physicianswith modern data science and analytics technologies to increase hospital revenue. FairCodebridges the gap between a hospital’s attending physicians and hospital coders. The result? Patient acuity and Case Mix Index are more accurately captured with the correct DRG, and hospital reimbursements adjust accordingly. DRG Validationand physician conducted medical chart reviews happen in real time, significantly impacting hospital quality rankings, case mix index (CMI)and bottom-line results. From clinical validationand chart reviews to payor denial defense, FairCode’sphysicians and data scientists are part of a hospital’s coding team. Add FairCodeto your existing CDI initiatives and see the difference. Outcomes are measurable and significant. FairCodeaverages greater than 4:1 Gross Return on Investment.

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