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Sustaining a Hybrid Telehealth Services Model

Kem Tolliver, CMOM, CPC, FACMPE
President, Medical Revenue Cycle Specialists
Bowie, MD

Due to the ongoing demands of running a busy medical practice, many of us have prioritized immediate telehealth needs while putting future telehealth considerations on the back burner. Now that we are more than halfway through the year, it is a good time to start thinking about sustaining a hybrid telehealth services model.

PHE Waivers

While awaiting further legislation on extensions to the public health emergency (PHE) telehealth waivers and the S. 4375 (116th): Telehealth Modernization Act, you can use this time to prepare for upcoming changes. If you are not already familiar with the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, you can review the most recent list (updated on May 24, 2021) found at Staying up to date on the latest PHE waivers is critical to building a long-term hybrid telehealth services model. It is also important to check with your state’s PHE waiver because it may not align with federal waivers.

The development of a sustainable hybrid telehealth services model includes outlining the regulations that will affect your organization in the future, as well as developing a strategic plan to address ongoing needs. On June 30, 2021, the US Department of Health and Human Services launched a calculator tool to help administrators and clinicians improve capacity to treat patients with COVID-19 with monoclonal antibodies. The Monoclonal Antibody Infusion Calculator allows you to input the number of infusion bays/beds, average daily patient volume, and administrative and clinical manpower to determine the average patient time in hours for each infusion session. These are the types of analytics that can be used to scale future telehealth services. This calculator can be found at

Telehealth Reimbursement

Providers are benefiting from the Centers for Medicare & Medicaid Services’ waiver, which allows telehealth services to be reimbursed at the same rate as in-person office visits. It is not surprising that the overutilization of telehealth services could have a downstream effect on physician reimbursement as insurance companies attempt to ensure that they are paying for the same level of effort, complexity, and medical decision-making for telehealth versus in-office care. As payers are relying on utilization review protocols, providers should ensure that documentation of telehealth visits demonstrates the same effort and risk for morbidity and mortality as if those visits were conducted in person. One way to ensure that the level of risk is fully demonstrated in provider encounter documentation is to leverage Hierarchical Condition Categories (HCCs). HCC risk scores allow payers to forecast healthcare costs for beneficiaries. The use of unspecified International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) codes will lower illness complexity, thereby misvaluing actual healthcare expenses.

Telehealth reimbursement guidelines for Medicare, Medicaid, and commercial payers have been a moving target throughout the PHE. Although many payers are following Medicare’s lead, this is not always the case. To eliminate gaps in reimbursement, it is important to stay in touch with commercial payers on a regular basis to determine when telehealth reimbursement waivers end and to identify changes to previous telehealth policies. Commercial payers’ policies regarding the reimbursement of audio-only visits should also be investigated if this is a mode of service delivery that your organization is utilizing.

With the use of telehealth service delivery, it is imperative to continue prioritizing social determinants of health (SDOH). There are ICD-10-CM codes ranging from Z55 to Z65 to report patients’ SDOH. These codes allow for demonstrating complexity while also customizing future telehealth service needs based on tracking and trending SDOH ICD-10-CM code utilization.

Sustaining a Hybrid Telehealth Services Model

Now that we have dipped our toes into the telehealth lake, it is time to dive in and immerse ourselves in sustainability models that are customized for our individual organization’s needs and that take into consideration internal and external forces that may cause us to pivot and refocus our efforts.

Managing Schedules

Scheduling has not become easier by adding telehealth into the mix. In fact, the management of schedules has become a much larger issue than many anticipated. Not only are we keeping track of patient visits, but we are also managing our providers’ and staffs’ in-office and telehealth schedules. Implementing a workforce management platform that aligns with patient schedules helps administrators keep track of where everyone needs to be. Color-coding telehealth visits and visit types is another helpful strategy. In-office visits are longer and more expensive than telehealth visits; blocking in-office visit times allows for effective manpower utilization. Filling in schedule holes with telehealth visits boosts provider productivity. To avoid exacerbation of chronic illnesses, it is also important to prioritize preventive services—many of which can be done via telehealth.

Prioritizing Patient Engagement

Many patients are still nervous about receiving virtual care. You can minimize their concerns by educating them about the effectiveness of telehealth services. Inform them about your organization’s security measures and offer general insurance benefit information, which lends greater credibility to telehealth services.

You can use your organization’s website and social media accounts to dispel myths and promote reliable information. You can also optimize the time that patients spend waiting in virtual or in-person waiting rooms by providing education through posters or prerecorded audio messages.

Because patients have busy schedules, it is critical to send them periodic reminders leading up to their appointments; this increases the likelihood that they will keep their appointments. Post-telehealth visit follow-up is equally important, to reduce barriers to care.

Automating the registration process can help patients take a more active role in the financial clearance process. Patients need to know that they are ultimately responsible for their medical bills and including them early on and throughout the process encourages a hands-on approach to their care. Insurance guidelines vary by payer, which is why eligibility verification is necessary. Batch eligibility checks can be a time-saver in this process. Bringing this process to completion includes notifying patients of their financial responsibility prior to their visit. Eliminating unnecessary paper documents, which can prolong office visits, is an important element in a sustainable hybrid telehealth model. Several of these forms can be automated and questions can be restructured to make them more user-friendly, reducing the amount of time it takes to complete them, as well as the number of questions directed to intake staff.

Many patients want their healthcare experiences to be more like their online retail experiences. Therefore, it is important to evolve with the times and offer patients convenient digital payment options for all visit types.

Article provided through a partnership with
Practice Management Institute
Michigan Society of Hematology & Oncology

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