Bringing together a cross functional team for virtual visit implementation success

by Suzi Tschetter, CPA

The Cleveland Clinic was founded on a collaborative clinical care delivery model, and we thrive on implementing long term projects bringing together cross functional teams for success.

Since 2019, we have been working with a handful of payers on implementing virtual patient care delivery and billing processes. We pulled together a cross functional team to address all aspects of this new workflow. We had developed a process from scheduling to billing that addressed the unique requests of each payer including specific Current Procedural Terminology (CPT®) codes and place of service. Because of that initial work, we were well positioned to quickly expand our process to accommodate the expanded list of CPT codes included in the Medicare telemedicine waiver as a result of the novel coronavirus (COVID-19) pandemic.

Our coding compliance team did the initial review of the Medicare waivers and communicated those codes to a variety of teams. With engagement from provider education, playbooks were developed to educate our coders and clinicians on what services could now be provided via Medicare-covered telemedicine. In a majority of cases, we decided it would be more streamlined to use existing charge capture workflows and charge codes for consistent revenue reporting. Our IT area was able to apply new logic based on encounter or visit type to identify which charges were performed virtually versus in person into apply unique coding and billing requirements for telemedicine. Work queues were built in the short term to validate coding on the virtual care charges.

Our contracting area engaged with all of our payers to determine their alignment with the Medicare waiver. They successfully compiled the unique requirements for billing these services for each payer as some requested claims logic that differed from Medicare. These unique billing scenarios were implemented by our IT claims team so that we had consistent workflows by payer, reducing the possibility of denied claims. While some of this logic had been in place for our 2019 workflow, much of this build was unique and required extensive testing for reliance on the new workflow

Throughout the entire process, our physician champions ensured we had the organization’s support to build or implement these new processes. They embraced the revenue cycle processes and further enhanced technology for a seamless patient experience. We believe the underlying structure built for this short-term crisis could support virtual visit workflows in the long term if some of the list of CPT codes remain.

Author bio

Tschetter is the director of revenue integrity at the Cleveland Clinic in Independence, Ohio.