As the COVID-19 public health emergency subsides, pandemic health orders are quietly lapsing in some states. Telehealth patients may find their access severely limited or outright unavailable.
Telehealth has allowed patients to be virtually treated by a healthcare provider over the Internet, eliminating the need for in-office visits. Under pandemic health orders, patients were allowed to see physicians 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.
The Rise of Telehealth
The COVID-19 pandemic has forever changed how companies and consumers interact. 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 how 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:
- According to a 2022 Census Bureau’s Household Pulse Survey, 1 in 4 respondents reported using telehealth services in the previous four 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 had 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 entirely ready for change with the times.
The 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 used to seeing doctors from anywhere in the country will not have that choice if their state reverts to standard 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 nationwide 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 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 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 contradicts 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 incapable of practicing medicine or with histories of negligently acting. 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 records.
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 two 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 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. Ninety 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 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.
5ACVO’s 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.
Medical organizations can get their physicians to work faster when to receive a fully credentialed file; all they have to do is:
- Provide 5ACVO with a signed release.
- Evaluate the completed file from 5ACVO.
- Present the evaluation to the necessary Board for a decision.
Sometimes, our providers can start billing one month after beginning the process. Faster credentialing also results in less work for providers and office staff.
Fifty-two tedious steps to credential a provider takes time and resources. We can free your staff from tracking down forms, confirming certificates, and everything else the process demands. Your team can devote their time to their patients.
The Value of Licensing
Medical licensing is another process providers must undertake before legally treating patients. This specifically requires providers or their office staff to:
- Complete and submit the application to the state board where 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. They can also help with COVID-19 Business Recovery. 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 and licensing providers faster than traditional methods. Anders Health Care advisors can manage all the administrative tasks that make up medical licensing, relieving providers’ headaches.
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 toward 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, which 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, 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.
More information about 5ACVO
5ACVO is a 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.
