As the COVID-19 public health emergency subsides, pandemic health orders are quietly lapsing in some states. Patients who use telehealth may find their access is severely limited or outright unavailable.
Telehealth has allowed patients to be virtually treated by a healthcare provider over the Internet, all but eliminating the need for in-office visits. Under pandemic health orders, patients were allowed to see physicians who were licensed in other states. Once the orders expire, patients must find physicians in their state.
Only 12 states in the country still permit virtual visits. California and New Jersey are expected to let their pandemic orders expire soon. The rise of telehealth may hit a brick ceiling as pre-pandemic regulations take over.
Rise Of Telehealth
The COVID-19 pandemic has forever changed how companies and consumers interact with each other. This is probably most evident in the healthcare industry. Giving patients the option to be treated via video calls helped increase public safety and peace of mind.
Providers and insurance companies have been forced to change the ways they see patients and do business. The first quarter of 2020, when the pandemic ramped up, saw the number of telehealth visits increase by 50%. Physicians had to keep up with demand. 66% of Medicare users reported their regular providers offered telehealth, an 18% uptick from 2019.
Another survey found that before the pandemic, approximately 2% of The University of California, San Francisco’s outpatient appointments happened via video calls. The percentage jumped to 60% during COVID-19’s peak.
More statistics lend credibility to telehealth’s potentially long-term popularity:
- Medicare reimbursement is higher for telehealth.
- According to a 2022 Census Bureau’s Household Pulse Survey, 1 in 4 respondents reported using telehealth services in the previous 4 weeks.
- The same survey found that the highest rates of virtual visits were among those with Medicaid (29.3%).
- The American Hospital Association found that 76% of hospitals in the United States connect with patients and medical consultants via video.
- 35% of people would probably replace their primary care providers with those who practice through telehealth.
- Another survey concluded that telehealth has inspired 40% of patients to communicate more with their physicians.
Telehealth’s popularity overshadowed the sneaky reality of the world after COVID-19, that the medical industry was not completely ready to change with the times.
Threats To Telehealth
Traditionally, healthcare providers must be licensed in the state where their patients are located, even if they are licensed somewhere else. Patients who are used to seeing doctors from anywhere in the country will not have that choice if their state reverts to normal licensure regulations.
Johns Hopkins Medicine says that almost 1 in 10 of their telehealth visits is with patients who live where the health system does not have physical operations. Now office staff must confirm patients’ locations to see if they are eligible for telehealth visits. Healthcare providers are typically licensed by their state medical boards. Proponents of this system claim it protects patients from harm and reduces the number of illegal prescription drug sales.
However, opening the borders allows physicians across the country to work together to treat patients and evolve their field. Patients could also see specialists from all over or when none practice in their region. Although they are well-intended, licensure regulations can damper provider and patient expectations.
Hope For Telehealth
Telehealth supporters should not lose hope. One report suggests that policymakers want to see more evidence that ensures telehealth does not replace in-person services or create opportunities for fraud before they go all in on the practice. Positive patient satisfaction and a decrease in no-show visits seem to spark serious interest among several states’ medical boards.
However, interstate licensure remains a sore spot among certain industry groups. Replacing the current medical review board structure to accommodate popular demand runs counter to particular interests. Fortunately, the debates about this topic are far from over.
The Need For Fast Credentialing And Licensing
While the healthcare industry tries to adapt to telehealth, healthcare providers must still follow current rules. They must be credentialed and licensed before they can practice medicine. The process takes time – sometimes too much time. Fast credentialing and licensing can get providers to work quickly so they can see their patients sooner.
What is credentialing? Why does it take so long? Who can a provider turn to when they seek their license?
The Importance Of Credentialing
Every legitimate healthcare provider must be appropriately credentialed. Patients should feel confident that their physicians are qualified to practice medicine. They place their lives into other people’s hands.
Credentialing can eliminate providers who are incapable of practicing medicine or have histories of acting negligently. Credentialing can help reduce the number of patient injuries and deaths. Medical practices and other relevant organizations that push their providers through the credentialing process can lower their chances of dealing with costly medical malpractice lawsuits.
Credentialing is also necessary before providers can enroll in health plans and networks. Insurance companies do not want poorly-performing physicians on their plans. Negligent doctors can cost them big money if they continue their shoddy record.
Traditional credentialing consists of 52 intricate and time-consuming steps that include office staff and administrators:
- Sending, tracking, and receiving the provider application packet.
- Obtaining the provider’s release and privilege forms.
- Reviewing the disclosure’s questions and answers.
- Evaluating the explanations of time gaps and claims history.
- Assessing medical malpractice claims history.
- Acquiring applicable certificate copies of Board, ECFMG, Medical School, Internship, Residency, Fellowship, and 2 years CME.
- Obtaining copies of government-issued photo ID, Malpractice, DEA, and CDS as well as CPR, ACLS, and PALS certificate copies.
- Acquiring TB, MMR, varicella, and flu vaccination records.
- Obtaining an Allied Health Professional’s Supervising Physician’s Statement.
- Verifying Board certification.
- Reviewing and confirming AMA and/or AOA Profile.
- Authenticating medical school internship, residency, fellowship, and affiliations.
- Collecting professional peer references.
- Researching primary and out-of-state licenses for disciplinary actions.
- Getting a copy of the provider’s current certificate of insurance.
- Performing an extensive 10-year criminal background check.
- Running a National Practitioner Data Bank query.
The standard credentialing process can take an average of 90 to 120 days. 90 days can be too long for medical organizations to wait for revenue during this unsteady economic climate. They need to get paid to remain solvent. They need to have their providers credentialed faster. What if something goes wrong during the process? They will have to wait even longer.
If any problems happen during any of the 52 action steps, credentialing can easily stretch past the 120-day window. Medical practices could suffer bankruptcies during this time.
Conventional credentialing takes too long, but it does not have to.
CVOs Offer Faster Credentialing
5ACVO is a member of Fifth Avenue Healthcare Services. We have streamlined the credentialing process for healthcare providers and their practices. We have taken the conventional 52 credentialing steps and pared them down to 6 simple steps to complete a credentialing file, ready for presentation to a board or committee for review and approval.
In some instances, our providers can start billing one month after beginning the process. Faster credentialing also results in less work for providers and office staff. 52 tedious steps to credential a provider takes time and manpower. We can free your staff from having to track down forms, confirm certificates, and everything else the process demands. Your staff can devote their time to their patients.
CVOs Can Reduce Credentialing Risk
We want to help you serve as many patients as possible while generating efficient revenue. Our smarter credentialing can reduce your credentialing processing time which increases available billing time. Our services are typically 5-7 days faster than in-house credentialing. They can also reduce risk.
By removing and replacing the most critical hazards from credentialing, we can provide the most effective control of the process to our providers.
The Value of Licensing
Medical licensing is another process providers must undertake before they can legally treat patients. This specifically requires providers or their office staff to
- Complete and submit the application to the state board in which you want a license.
- Contact every primary verification source.
- Disclose all professional adverse actions.
- Submit all the documents to the board for review.
- Follow up with sources.
The time it takes to receive a medical license varies from state to state. Flawlessly completing each step can shorten the time. However, busy physicians might not have the time to take on each task as diligently as they should.
Licensing with Anders CPAs + Advisors
Anders Health Care, the healthcare specialty group of Anders CPAs + Advisors, can perform most if not all the licensing responsibilities for providers.
Anders CPAs + Advisors is a trusted partner of 5ACVO and the other Fifth Avenue Healthcare Services companies. Founded in 1965, Anders CPAs + Advisors specialize in Audit and Advisory, Family Wealth and Estate Planning, and Tax Planning and Compliance. They can also help with COVID-19 Business Recovery, SOC Reports, and more. Anders serves multiple industries, including Banking, Finance, Construction, and Real Estate.
Anders Health Care can manage a physician’s licensing needs, including state, controlled substance, and DEA applications in all 50 states. The team of experts understands the ins and outs of each state’s requirements. They can leverage their expertise to expedite and streamline procedures for their clients, licensing providers faster than traditional methods.
Anders Health Care advisors can manage all the administrative tasks that make up medical licensing, relieving providers’ headaches along the way. Providers can better nurture their organizations and provide the best patient care possible.
Anders and 5ACVO
Licensed providers must complete the credentialing process and provider enrollment process if they want to begin billing patients with payors. Although we here at 5ACVO and the Fifth Avenue Healthcare Services family do not apply for state licenses for providers, our credentialing and provider enrollment services bridge the gap from licensing to billing.
If providers need assistance acquiring their license, they can call or email their 5ACVO point of contact who can connect them with the right people at Anders.
The Necessity of Provider Enrollment
Whether they see patients virtually or in person, providers can only bill a health plan or network if they are enrolled in one. Provider enrollment involves credentialing, applying, and contracting with payors. 5ACVO can collaborate with its sister company Primoris Credentialing Network to help providers overcome one more hurdle towards billing.
Instead of applying to each health plan or network one at a time, providers can use Primoris to apply to 25+ delegated options with one application. This shortcut can save providers time and energy, two things that could be in short supply in the often-hectic medical industry.
The Primoris’ team has 385+ years of combined industry experience. With so much knowledge at their disposal, they have nearly perfected provider enrollment. They have taken the guesswork out of the entire undertaking, keeping everything as simple as possible. They understand the necessity of provider enrollment and strive to give an accurate and faster service to all providers.
The Benefits of Teamwork
5ACVO and Anders CPAs + Advisors can get providers credentialed and licensed no matter how the telehealth debate ends. Our seamless partnership with Primoris Credentialing Network helps expedite provider enrollment. We can all work together to get providers to work faster so they can drive revenue to their practice. Just like physicians encouraging their patients via telehealth, we support our providers to make their jobs and lives better.
More information about 5ACVO
5ACVO is NCQA Credentialing Accredited CVO specializing in credentialing and primary source verification and is part of the Fifth Avenue Healthcare Services family. 5ACVO sister companies include Fifth Avenue Agency (MPLI and medical malpractice insurance specialists) and Primoris Credentialing Network (credentialing and provider enrollment specialists with 54+ health plan and network provider enrollment options).
This article was initially published by 5ACVO here. For more information on 5ACVO, please visit 5ACVO.com or Contact Us.
