Primary care physicians form the backbone of the medical service delivery ecosystem. Primary healthcare providers are responsible for keeping the overall health of the population strong and providing essential assistance to patients in case of any advanced need. Primary care providers have also been some of the busiest practitioners during the Covid-19 public health emergency (PHE). To accommodate the unprecedented demand for primary care during the beginning of the pandemic, several federal health authorities like the CMS had relaxed several rules for revenue cycle billing. Two years later, in 2022, many of the temporary regulations have been scrapped. But are the primary care providers benefiting from the new rules? This blog will take you through the changes in primary care revenue cycle billing with the public health emergency coming to an end.

Decrease in Payments

Payments for primary healthcare providers will see a downfall, as is evident by the conversion factor and the use of the 2022 physician payment schedule. The American Academy of Family Physicians has reiterated the same concern. The issues that could negatively impact the collections from primary care revenue cycle billing are:

  • The dip in the 2022 Medicare physician fee schedule could be why the family practices and primary care providers could see a decrease of 1.6% in their allowed charges.
  • The AAFP also pointed out that primary physicians incur an increased cost in their clinics while protecting their staff and the patients from Covid-19. The code used to reimburse for that cost, 99072, still has a status B. Several primary healthcare providers have said that switching code 99072 to status A could help them recover from losses and account for the additional expenses.
  • Most primary care physicians are not being paid at par with the 2022 payment rates by their employer. The AAFP reports that most employers use the 2020 fee rates to pay their physicians. On the other hand, they use the increased payment rates for outpatient services corresponding to codes 99202-99215 to compensate for their loss.

These issues have cumulated to decrease the payments for the primary care providers in 2022 in a post-PHE scenario, which could significantly impact the revenue cycle billing ecosystem.

Optimized Use of Telemedicine

Telemedicine has seen a drastic increase in its use during and after the pandemic. According to a report from the Medicare Payment Advisory Commission, from only a few hundred thousand virtual visits a month in February 2020, a month before the pandemic, the number had gone up to over 8 million telehealth visits in April 2020. Telemedicine services made care more accessible to the patients. It was made possible because CMS lifted almost all site restrictions on remote visits and allowed physicians to bill at the same rate as an in-person visit till the end of the PHE. Audio-only telephonic visits were also able to cater to the specific needs of the patients who were not comfortable with video interaction.

The CMS has announced that it will retain most of the telehealth services listed in Category 3 till the end of 2023. The CMS has also proposed that the audio-only services replace the definition of “interactive telecommunications system” for tele-mental-health services. However, the CMS also requires that an in-person visit be held within six months of a telehealth mental health service. Several primary care physicians have objected to this requirement, stating no scientific evidence to support this in-person visit.

With telehealth being one of the significant areas of concern in the primary health care space, it is crucial to note the allowed charges for telemedicine. Assigning the proper codes and preparing a correct claim for the telemedicine service in primary care will help providers improve their revenue cycle billing.

Diversity in Payment Models

The need for change in payment models has been well-spoken by various healthcare leaders. Again, it is reiterated in the post-PHE revenue cycle billing discussions for primary healthcare physicians. Providers need to move over traditional payment models and adapt to the latest digital payment methods, making their revenue cycle billing easier. Payment trends in the healthcare industry show that about 75% of patients prefer to pay healthcare bills online. However, only 25% of the providers feel that they can extend digital payment methods to pay for their services.

Adapting to diverse payment models could help primary care providers collect more revenue without frequently following up on the collection process. Extending support to the patients’ needs also boosts the revenue cycle billing process with a smoother cash inflow from different payment channels.

Apart from digital channels, the Comprehensive Primary Care Plus model could also be a viable way to improve revenue cycle billing in primary healthcare practices. It combines traditional fee-for-service payments, upfront per-beneficiary per-month fees, and performance-based incentive payments. It is also a step forward in the value-based care model envisioned by the CMS. Healthcare leaders in the primary care domain have expressed that having multiple payment channels instead of just the traditional route could be a great start to aim at better financial stability and steadier cash flow into the family practice.

Disparity in Remote and In-person Visit Charges

During the pandemic, Medicare allowed the same payment rates for telehealth visits in primary care as in-person visits. CMS also took off several site restrictions regarding the remote visits for primary care providers. However, these changes have been discontinued in light of the end of the public health emergency. Medicare has admitted that due to this rule, Medicare’s expenditure had been very high to cater to the needs of telemedicine.

There have also been several fraud cases to loot undue money from the insurance carrier. Apart from Medicare, many private players have expressed their concern regarding telemedicine visits and said that their expenditure has been going over the top due to them. Most primary care provider organizations have advocated the need to make these temporary rules permanent to build a better primary care delivery ecosystem.

While there have been several changes in the post-PHE scenario in the medical industry, not all are favorable to primary care physicians. However, with the suitable modifications targeting the industry’s pain points, the primary care revenue cycle billing could look more assertive on the other side.

We hope this blog helped you understand the revenue cycle billing changes for primary healthcare in the post-public health emergency era. Comment your queries down below, and we’ll get back to you. Please subscribe to our blog for more news on healthcare, financial management, and technology. Follow us on Facebook, Instagram, Twitter, and LinkedIn.