In the wake of the COVID-19 pandemic, the movement towards feasible, rapid and safe healthcare services has been a top priority for healthcare organizations across the country. Healthcare organizations and physicians have opted to offer standard medical visits, checkups and treatment in the form of telehealth services that can be offered across various virtual platforms.
As a healthcare organization, it is key to provide services and collect payment within the means of individual healthcare providers and maintain compliance with the ever-changing federal and state regulations. Now more than ever, healthcare organizations are finding it difficult to keep up with these requirements and collect on services rendered. Internal audit can play an important role in evaluating current processes and providing recommendations to refine and enhance future processes to minimize legal and financial risk to the organization.
8 questions internal audit should ask in evaluating the charge capture process over telehealth
- Has the organization assigned responsibility for the charge capture process over telehealth services?
- What policies and procedures are in place to address the charge capture process over telehealth services?
- Is there a function focused on the compliance between the organization and federal, state and individual payor rules and regulations?
- What type of service is being provided; telehealth, virtual check-in or e-visits?
- In what departments or locations is telehealth being conducted within the organization?
- What technology or platforms are being used to provide medical treatment virtually?
- What charging methodologies are being used?
- Is on-going monitoring of both accepted and denied claims being performed?
Mitigating legal and financial risk should be a priority for internal audit. Internal audit should review:
- The current federal and state regulations to maintain compliance with services being offered and the ability to collect on those services.
- Service agreements or provider contracts to ensure the organization is current with provider requirements related to the coverage of telehealth services prior to being rendered.
- Paid and denied claims to the organization to analyze trends or commonalities between services rendered, accepted/denial reasoning and the corresponding insurance provider.
- The root cause analysis surrounding denied claims and timely follow up to ensure rejected claims are investigated for resolution timely.
- The documentation by the physician to confirm that a proper consent form is present, patient identification is established, duration of visit is logged, and location of care team and residency of patient is noted.
- Health Insurance Portability and Accountability Act (HIPAA) safeguarding tools and techniques have been implemented to ensure protected health information (PHI) and personally identifiable information (PII) security in an effort to avoid costly breaches and violations.
5 key takeaways to minimize risk in the charge capture process of telehealth services
- Ensure the organization is current with federal and state regulations regarding telehealth services
- Analyze commonalities of accepted and denied claims with related reasoning and corresponding insurance provider to understand trends within your organization
- Review patient encounter documentation to determine physicians are in compliance with payor requirements
- Perform reconciliation efforts of denied claims to ensure maximum charge capture
- Ensure telehealth services are conducted under HIPAA safeguarding requirements
For more information on this topic, or to learn how Baker Tilly healthcare-specialized Value Architects™ can help, contact our team.