As of May 11, 2023, the COVID-19 public health emergency (the PHE) is ending in the United States. While many are breathing a sigh of relief, revenue cycle professionals will be navigating a potentially confusing mix of shifting reimbursements and waivers, some of which support a decision to outsource medical billing.
For example, the extension of telehealth services during the PHE has been extended through the end of 2024 (as part of the Consolidated Appropriations Act) but the continuous enrollment provision from the PHE ended on March 31, 2023. And this is just at the federal level. Many waivers and reimbursements are subject to state decisions and management.
So, what does this mean for revenue cycle leaders? First, make sure you’re taking time to understand your specific starting point. CMS has published a list of 16 fact sheets, and it will be worth reviewing the one that applies to you (for example, some options are available for home health, hospitals, or durable medical equipment) .
Beyond this, now is a good time to start reviewing your patient mix. Facilities with a large proportion of Medicaid users will see more disruption than those who don’t. This is because, since March 2020, continuous coverage has been required and terminations were barred, but as of April 1, 2023, states are reviewing eligibility, meaning families and individuals could be thrown off the roles and might need support in maintaining coverage.
At the same time, it’s worth being mindful of internal disruption. Your employees will likely be impacted by the end of the PHE, from vaccine access to benefits that are available to friends and family, so consider a few conversations to make sure you understand how your staff might be affected.
But ultimately, this change is right around the corner and might be too much to handle for revenue cycle leaders who already have enough to deal with. The vast majority of RCM leaders should look for areas where options to outsource medical billing can ease their work and free them up to manage the sea of change that’s on the horizon in the healthcare revenue cycle.
Hemant Apte, Chief Executive Officer in
Hemant Apte, Founder & Chief Executive Officer of 3Gen Consulting, is a seasoned executive leader with deep domain expertise in US healthcare management practices. He founded 3Gen Consulting in 2006 and has been instrumental in offering thought leadership to his clients and providing services and solutions that are unique in the market.