Exploring the Impact of Telehealth on Remote Reimbursement Audit 

Updated on October 2, 2023
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As technology continues to advance rapidly, it is no surprise that several strategies have already been adopted to cope with the growing need for accessible healthcare following in its tow. One of the many that have already been proven useful, especially when the pandemic hit, is telehealth. 

With the digital age at its peak, telehealth stands at the forefront of this new healthcare revolution. Telehealth is accessing healthcare remotely and through digital communication technologies. Typically, patients book appointments online and get consultations from physicians by means of live video conferencing or mobile health apps.

Telehealth includes telemedicine, remote doctor consultations, remote health monitoring, and even the keeping of personal health records. This paradigm shift in healthcare delivery displays overwhelming benefits but not without its challenges.

The beneficial results of telehealth include a growth in the number of patients seeking telemedicine appointments and remote consultations. It also changed how patients and health providers interact, breaking the distance barriers and offering flexibility. The new telemedicine development also translates to patient medical records and billing data being kept electronically, easing remote access. 

However, this surge of technological ease and patient demands brings forth some challenges in background operations. As telehealth advances, so should the other aspects of healthcare that are working in the background. Healthcare reimbursements and the audit that comes with them are crucial processes that make sure healthcare services are appropriately billed and reimbursed. 

A complex process for most to understand, medical billing often feels overwhelming for some providers. It involves identifying patients’ insurance and filing claims, then waiting for the payer’s adjudication. The ideal process ends with Medicare or Medicaid or the patient’s insurance reimbursing your services. Otherwise, when denied, the process has to be repeated with the patient’s secondary insurance if there is, or billed to the patient directly.

Here’s a helpful guide for a complete run-through of the medical billing process.

This is how the role of a reimbursement auditor is crucial in lessening the chance of an unnecessary back and forth of the billing process. However, with the changes in the process of accessing healthcare, auditors are now experiencing the pressure of adapting their own strategies to be effective in their roles.

They face some challenges in ensuring that documentation is kept accurate and within regulatory compliance, especially in remote settings. They are posed to navigate the added challenge of verifying that appropriate billing codes for specific services are implemented to guarantee correct reimbursements. 

More than accuracy, auditors must now collaborate with cybersecurity teams as ensuring the security of telehealth data and protecting patients’ privacy is of utmost importance. This also includes working to mitigate the risk of fraudulent billing activities. 

Managing these increasing demands and operation challenges requires remote strategies for reimbursement audits to be implemented. Eventually, the process of remote reimbursement audit was birthed. Reimbursement auditing done remotely also comes with numerous opportunities and advantages in streamlining operations.

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One of its main advantages is the enhancement of data accessibility. With medical records being accessed remotely, auditors now have real-time access to patient data. Data retrieval and analysis, as well as identification of discrepancies, have become efficient and straightforward. 

Employing the right tools and technologies, auditors can conduct audits from anywhere, reducing overhead costs of on-site visits. This results in enhanced reachability as they can reach more expansive geographic areas, which means a speed-up process as wider reach also means improved auditing scalability.

As telehealth leads the way to digital advancement, regulatory bodies must adapt and issue more advanced guidelines and regulations to cover any loopholes. With telehealth expanding to more services and new policies being written to cover these changes, it is essential that auditors review any updates on the scope and eligibility of telehealth in specific services. This also includes learning how they execute their roles remotely, can impact any processes, and ensure complete compliance.

Here’s an excellent resource for a list of telehealth policies: https://telehealth.hhs.gov/providers/telehealth-policy

Healthcare is facing a transformative era as it embraces the ever-advancing digital revolution. While this is mostly a good change, it opens some challenges to everyone involved in healthcare. One of the drawbacks of the telehealth advancement is leaving healthcare providers clueless about the technicalities of how the whole process works. 

This allows reimbursement auditors to conduct relevant seminars and consultations to ease their burden. Reimbursement auditors can also offer remote oversight services with ongoing monitoring to guide healthcare professionals through the complexities until they are ready to operate independently.

In the end, this progress is just a part of the ongoing commitment of the healthcare industry to continuous learning and innovation. The medical field is all about exploring new approaches, methods, and technologies that improve better patient outcomes. By embracing these changes, they are equipped to provide sustainable solutions for an array of challenges that have risen over the past decades.

The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.