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Covid-19: Where Things Stand with the USA Based Healthcare BPO?

Sujin Jekash Simson

CEO & Founder, Medryte Healthcare Solutions

A Look-over at the struggle of Private Practice Owners 

The global economy is on a downturn from past three months due to COVID-19 crisis. Globally, several countries are undergoing various changes due to Covid-19 which has halted almost all the business operations in all the sectors including USA based healthcare BPO services.

Several private practice owners in the United States are struggling over the complicated situation with empty clinics including financial crunch for the past one month. Many providers don’t have money to pay rent, utensils or staff. The economic fallout led by the pandemic may lead to the closure of many small private practices for short term.

Notwithstanding the immediate setbacks inflicted by the pandemic, small private practice owners may have better opportunities in the post-pandemic world. The small private practices may merge with the large network of providers which may enable them to continue their practices.

It’s worth notable that the first Medicare stimulus package $30 billion has been distributed to the healthcare providers and SNF’s. HHS has started to distribute the second stimulus package $20 billion from April, 24 to the providers. This can hopefully give temporary relief for the private practice owners to some extent, but could hardly give a solution for their disrupted cash flow.


Telehealth- the Glimmer of Hope for Providers

Telehealth has been a part of the medical field for several decades, but its use is markedly increased as the world is grappling with the COVID-19 outbreak. The pandemic has brightened the hopes of the telehealth providers.

In United States, the payers including the Centers for Medicare & Medicaid Services (CMS) have broadened access and flexibility in using telehealth services. Most of the payers now allow the providers to use telecommunications platforms like Skype, FaceTime, and Zoom.

According to the preeminent research and consulting firm Frost and Sullivan, the month of March has seen an incredible surge in the telehealth visits by over 50%. Moreover, the analysts of Forrester estimate that the coronavirus-related virtual visits could soar 900 million this year based on the current projections by COVID-19 infections in the U.S. As per the prediction, the general medical care visits may top 200 million which was earlier expected to top 36 million visits this year.

The American administration reduced a major cost barrier for telemedicine adoption by smaller physician practitioners. It declared that Medicare and Medicaid would pay the same rates for virtual visits alike in-office appointments.

Right now, addressing the overflowing patients seeking virtual care remains a challenge for both small practitioners and larger telemedicine providers. It’s a challenge for the providers because many providers lag in providing essential services like supporting staff for scheduling appointments and in the documentation.


A Deep Dive into the Current Situation

As it continues to rattle countries and economies, the coronavirus is expected to hit all the Healthcare BPO companies especially those working for private practices quite hard. Healthcare BPO companies that handle critical functions for the world’s largest corporation are being forced to halt large chunks of their operations. Governments’ travel restrictions decreased patients visits since the past few weeks. Telehealth services are thus the only scope for the private practice dependent medical billing companies for the next few months.

Contemplating the overwhelming opportunities, most of these companies started specialized training to their staffs on billing telehealth services, appending appropriate payer-specific modifiers, and place of services. Also, many companies started helping clients to schedule telehealth appointments which gradually increased patient visits.

The companies working for payers have less work, but comparatively these companies are doing better than the companies depending exclusively on providers. The companies working for payers on risk adjustment projects are mostly ideal without any work. Usually, HCC season starts from April of every year. But the upcoming HCC season will delay as CMS has suspended the risk adjustment data validation audit activities. Therefore, it is predicted that the upcoming HCC season may delay by four to six months.


The Concluding Note

Over the short term, there will be a huge revenue loss for all the healthcare BPO’s. Predominantly, well-established companies may have a wider impact.

But be hopeful, the situation will not last long. We all are up against a crisis, but if you look at history, human will power has always come out victorious. We have this unique gift of adapting, a positive attitude, and more importantly efforts to tackle any worse situation. Hence post COVID-19 will be a big opportunity for the healthcare BPO’s. I will share my view about the post COVID-19 opportunities in my next article.