4 October 2023

Digital Technology Guru

Digital Technology Guru Reviews

Understanding Payment and Coding in the Virtual First Care Era

2 min read
Understanding Payment and Coding in the Virtual First Care Era

The digital health era has transformed how patients interact with the healthcare system, making preventive services and chronic disease management more accessible. In this evolving landscape, it is essential to navigate the healthcare coding system effectively for sustainability.

Virtual first care (V1C) is a mode of medical care that emphasizes digital interactions and integration into everyday life. It takes a holistic, team-based approach to care delivery. However, fee-for-service reimbursement structures continue to dominate, not accounting for the unique considerations of V1C delivery models.

To address this issue, IMPACT, a collaboration between DiMe and ATA, has released the Payment & Coding Toolkit. This toolkit provides healthcare providers with industry-vetted best practices for effective reimbursement strategies within the current coding landscape.

Accurate coding is crucial for appropriate reimbursement, maintaining cash flow, and delivering quality care. Standardized coding practices also facilitate efficient processing of insurance claims, reducing delays and administrative errors. Additionally, coding guidelines produce valuable healthcare data that informs quality standards, reimbursement decisions, and outcomes research.

Traditional coding and reimbursement guidelines were designed for in-person visits, creating misalignment with V1C models. The IMPACT toolkit fills this gap offering a comprehensive resource tailored to the challenges faced V1C organizations. It includes an overview of payment and coding basics, a step--step guide for quality checks, a library of procedure codes, and real-life case examples.

The toolkit also highlights best practices from industry leaders. For instance, Dreem, a virtual sleep clinic, successfully navigated the coding landscape relying on existing CPT codes. Omada Health, on the other hand, collaborated with the American Medical Association to create a new CPT code for their online Diabetes Prevention Program.

The ultimate goal is to shape the future of healthcare increasing access to affordable primary and specialty care services. Appropriate payment and coding strategies will enable V1C organizations to achieve financial sustainability while generating the evidence needed to develop more innovative payment models.

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